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Published on: October 25, 2018
COVID-19 infection in myasthenia gravis: Clinical course and outcomes
Eleanor V Thomas1, Gabriela Bou1, Shawn Barton1
1Department of Neurology, Emory University, Atlanta, Georgia, USA.
Introduction/Aims:
Myasthenia gravis (MG) patients have been predicted to have high rates of coronavirus disease-2019 (COVID-19) complications due to frequent involvement of respiratory muscles in MG and frequent use of immunosuppressive therapies. We investigated outcomes of MG patients infected with SARS-CoV-2 to identify risk factors for exacerbation and severe disease.
Methods:
This was a retrospective analysis of 39 MG patients with SARS-CoV-2 infection from January March 1, 2020 to October 25, 2021 at Emory University. Patients' records were queried for demographic data, MG history, and COVID-19 treatments and hospitalizations.
Results:
At the time of infection, 8 of 39 were vaccinated, 30 of 39 unvaccinated, and 1 unknown. Average age was 52.6 years. Twenty-seven patients were receiving immunomodulatory treatments at the time of infection. Thirty-five of 39 were symptomatic, 21 were hospitalized, and 7 required ventilations. MG exacerbations occurred in 5 and were treated with therapeutic plasma exchange (n = 1), intravenous immunoglobulin (IVIg) (n = 1), and prednisone taper (n = 5). Four hospitalized patients died from COVID-related lung injuries. No deaths were attributed to MG exacerbation; however, one patient receiving IVIg for MG exacerbation had a pulmonary embolism. There were no deaths in fully vaccinated patients, and only one vaccinated patient was admitted to the intensive care unit.
Discussion:
High rates of COVID-19 complications and death were observed in this cohort of MG patients. Some patients with MG and COVID-19 also had an exacerbation during infection. Further studies are needed to determine whether MG patients are at higher risk for complications than the rest of the population.
Insights
Myasthenia gravis patients with COVID-19 experienced severe complications and death. Vaccination significantly reduced severe outcomes, highlighting its importance for this vulnerable population.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Myasthenia gravis (MG) patients are susceptible to severe COVID-19 due to respiratory muscle involvement and immunosuppressive therapies.
- Understanding COVID-19 outcomes in MG patients is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the outcomes of myasthenia gravis patients infected with SARS-CoV-2.
- To identify risk factors for exacerbation and severe disease in MG patients with COVID-19.
Main Methods:
- Retrospective analysis of 39 myasthenia gravis patients with SARS-CoV-2 infection.
- Data collected included demographics, MG history, COVID-19 treatments, and hospitalization records.
Main Results:
- 35 of 39 patients were symptomatic; 21 were hospitalized, and 7 required ventilation.
- Five patients experienced MG exacerbations; four hospitalized patients died from COVID-19 related lung injuries.
- No deaths occurred in fully vaccinated patients, and only one vaccinated patient required intensive care unit admission.
Conclusions:
- Myasthenia gravis patients with COVID-19 exhibited high rates of complications and mortality.
- Vaccination appears to be protective against severe COVID-19 outcomes in MG patients.
- Further research is needed to confirm if MG patients face elevated risks compared to the general population.
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