Risk of New-Onset Myasthenia Gravis Following COVID-19 Infection and Vaccination: A Population-Based Case-Control
Tasneem Kab1, Keshet Pardo1,2, Mark A Hellmann1,2
1Department of Neurology, Rabin Medical Center, Petach Tikva, Israel.
Background:
The potential link between myasthenia gravis (MG) and COVID-19 infection or vaccination remains unclear. This study aimed to evaluate the relationship between these factors and new-onset MG.
Methods:
A case-control study was conducted using Clalit Health Services' database. We applied a ML algorithm to reduce diagnostic misclassification. The study examined adults with new onset MG, aged 18 or older, between January 2020 and December 2022 for COVID-19 infection (Cohort I) and between January 2021 and December 2022 for Pfizer-BioNTech COVID-19 vaccine (Cohort II). For each new MG case, three controls matched by age, sex, and index date were selected. Prior exposure to either infection or vaccination was assessed within 90 and 180 days for cases and controls.
Results:
In cohort I, 253 new MG cases were identified. A multivariate logistic regression model showed an odds ratio (OR) of 1.44 (95% CI 0.708-2.92) within 90 days post-infection and 1.67 (95% CI 0.98-2.84) within 180 days. In cohort II, 177 new MG cases were detected, with an OR of 1.76 (95% CI 1.049-2.95) within 90 days post-vaccination and 2.45 (95% CI 1.51-3.95) within 180 days.
Conclusion:
This study suggests no significant increased risk of new-onset MG following COVID-19 infection, but the Pfizer-BioNTech vaccine appears to be associated with a higher risk of developing MG, particularly within 180 days of vaccination.
Insights
COVID-19 infection does not significantly increase the risk of myasthenia gravis (MG). However, the Pfizer-BioNTech vaccine may be linked to a higher risk of new-onset MG, especially within 180 days post-vaccination.
Area of Science:
- Neurology
- Immunology
- Epidemiology
Background:
- The relationship between COVID-19 infection/vaccination and myasthenia gravis (MG) is not well-established.
- Investigating new-onset MG following SARS-CoV-2 infection or vaccination is crucial for public health.
- Understanding potential triggers for autoimmune diseases like MG is an ongoing research area.
Purpose of the Study:
- To evaluate the association between COVID-19 infection and new-onset myasthenia gravis (MG).
- To assess the risk of developing MG after receiving the Pfizer-BioNTech COVID-19 vaccine.
- To analyze the temporal relationship between exposure (infection/vaccination) and MG onset.
Main Methods:
- A case-control study utilizing Clalit Health Services database.
- Machine learning (ML) algorithm applied to minimize diagnostic misclassification of MG.
- Analysis of adult new-onset MG cases and matched controls for COVID-19 infection (Cohort I) and Pfizer-BioNTech vaccination (Cohort II) exposure within 90 and 180 days.
Main Results:
- No significant increase in MG risk was observed following COVID-19 infection (OR 1.44 at 90 days, 1.67 at 180 days).
- An elevated risk of new-onset MG was associated with the Pfizer-BioNTech vaccine (OR 1.76 at 90 days, 2.45 at 180 days).
- The association between vaccination and MG was more pronounced within 180 days post-vaccination.
Conclusions:
- COVID-19 infection does not appear to be a significant risk factor for new-onset myasthenia gravis.
- The Pfizer-BioNTech COVID-19 vaccine may be associated with an increased risk of developing myasthenia gravis.
- Further research is warranted to understand the potential mechanisms linking COVID-19 vaccination to MG development.
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