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COVID-19 in patients with myasthenia gravis: a single-center retrospective study in China
Jiayi Li1, Yiming Zheng1, Yawen Zhao1
1Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Insights
Most myasthenia gravis patients experience mild COVID-19, but older individuals with comorbidities and high MG-ADL scores are at higher risk for severe symptoms. Certain immunosuppressants may also increase severity risk.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Myasthenia gravis (MG) patients may face increased risks from Coronavirus disease 2019 (COVID-19).
- Understanding COVID-19's impact on MG patients is crucial for risk assessment and management.
Purpose of the Study:
- To investigate the associations between COVID-19 and myasthenia gravis.
- To identify risk factors for severe COVID-19 outcomes in MG patients.
Main Methods:
- Retrospective cohort study of 134 myasthenia gravis patients (June 2020 - April 2023).
- Patients divided into COVID-19 and non-COVID-19 groups.
- Logistic regression analysis to identify risk factors for COVID-19 and severe symptoms.
Main Results:
- 80.6% of MG patients contracted COVID-19, mostly with mild/moderate symptoms (95.4%).
- Risk factors for severe COVID-19 included older age, comorbidities, rituximab use, tumors, Hashimoto's thyroiditis, and higher MG-ADL scores.
- Increased MG-ADL scores post-COVID-19 were linked to dry cough, oral corticosteroid use, and multiple immunosuppressants.
Conclusions:
- The majority of myasthenia gravis patients experience mild COVID-19.
- Older age, numerous comorbidities, high MG-ADL scores, and extensive immunosuppressant use are associated with increased risk of severe COVID-19 symptoms in MG patients.
Background:
Coronavirus disease 2019 (COVID-19) has been a great concern since 2019. Patients with myasthenia gravis (MG) may be at higher risk of COVID-19 and a more severe disease course. We examined the associations between COVID-19 and MG.
Methods:
This single-center retrospective cohort study involved 134 patients who were diagnosed with MG from June 2020 to November 2022 and followed up until April 2023. They were divided into a COVID-19 group and non-COVID-19 group. Logistic regression analysis was used to detect factors potentially associating COVID-19 with MG.
Results:
Of the 134 patients with MG, 108 (80.6%) had COVID-19. A higher number of comorbidities was significantly associated with an increased risk of COVID-19 (p = 0.040). A total of 103 patients (95.4%) had mild/moderate COVID-19 symptoms, and 4 patients (3.7%) were severe/critical symptoms (including 2 deaths). Higher age (p = 0.036), use of rituximab (p = 0.037), tumors other than thymoma (p = 0.031), Hashimoto's thyroiditis (p = 0.011), more comorbidities (p = 0.002), and a higher baseline MG activities of daily living (MG-ADL) score (p = 0.006) were risk factors for severe COVID-19 symptoms. The MG-ADL score increased by ≥ 2 points in 16 (15.7%) patients. Dry cough and/or expectoration (p = 0.011), use of oral corticosteroids (p = 0.033), and use of more than one kind of immunosuppressant (p = 0.017) were associated with the increase of the post-COVID-19 MG-ADL score.
Conclusion:
Most patients with MG have a mild course of COVID-19. However, patients with older age, many comorbidities, a high MG-ADL score, and use of a variety of immunosuppressants during COVID-19 may be more prone to severe symptoms.
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