Clinical Outcomes in COVID-19 patients with pre-existing myasthenia gravis:

A systematic analysis of reported cases

Authors

  • Ahmed Daif MD University of Illinois at Chicago
  • Tejal Gapchup University of Illinois at Chicago
  • Pritikanta Paul MD University of Illinois at Chicago https://orcid.org/0000-0001-9842-8803

DOI:

https://doi.org/10.17161/rrnmf.v4i4.20317

Keywords:

myasthenia gravis, covid-19, ivig/plex

Abstract

INTRODUCTION: Myasthenia gravis (MG) presents an additional challenge in managing COVID-19 as outcomes potentially depend on prior disease control and treatment. Yet the role of pre-existing MG in COVID-19 outcomes has not been established.

METHODS: We searched PubMed, Scopus, and Web of Science databases for reports of MG patients with confirmed COVID-19 until March 2022. We analyzed data on patient demographics, chronicity, and MG control at baseline pre-COVID, treatment history and outcome following COVID infection.

RESULTS: Twenty-nine publications with 119 patients (females n=75, age range 20-93 years, AChR Ab positive n= 65, MuSK Ab positive n= 5, seronegative n=14, unknown n=35) were included. Eighty-three (70%) were hospitalized, more than half with MG exacerbation. There was no significant difference in disease duration or control of MG symptoms at baseline between hospitalized and non-hospitalized. Hospitalization was associated with higher dose of daily prednisone but a comparable proportion of patients were on steroid-sparing agents. Among hospitalized patients, 40% were intubated uncorrelated with MG baseline control. Unfavorable outcome was not always associated with MG exacerbation. Amongst those discharged,75% received intravenous immunoglobulin (IVIG) or Plasmapheresis (PLEX) for MG exacerbation as compared to 67% with a fatal outcome didn’t receive either.

CONCLUSION: Preexisting MG does not appear to be associated with severe COVID-19 outcomes. Higher dose of prednisone prior to COVID-19 infection is associated with increased risk of hospitalization but MG control at baseline did not determine worse outcome. IVIG/PLEX appears safe and potentially can reduce fatality in patients with COVID-19 experiencing MG exacerbation.

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References

Kassardjian CD, Widdifield J, Paterson JM, et al. Serious infections in patients with myasthenia gravis: population-based cohort study. Eur J Neurol. 2020;27(4):702-708. doi:10.1111/ene.14153

Guidon AC, Amato AA. COVID-19 and neuromuscular disorders. Neurology. 2020;94(22):959-969. doi:10.1212/WNL.0000000000009566

Gilhus NE, Romi F, Hong Y, Skeie GO. Myasthenia gravis and infectious disease. J Neurol. 2018;265(6):1251-1258. doi:10.1007/s00415-018-8751-9

Galassi G, Marchioni A. Myasthenia gravis at the crossroad of COVID-19: focus on immunological and respiratory interplay. Acta Neurol Belg. 2021;121(3):633-642. doi:10.1007/s13760-021-01612-6

Županić S, Lazibat I, Rubinić Majdak M, Jeličić M. TREATMENT OF MYASTHENIA GRAVIS PATIENTS WITH COVID-19: REVIEW OF THE LITERATURE. Acta Clin Croat. 2022;60(3):496-509. doi:10.20471/acc.2021.60.03.21

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi:10.1136/bmj.b2700

Thomsen JLS, Andersen H. Outcome Measures in Clinical Trials of Patients With Myasthenia Gravis . Front Neurol . 2020;11. https://www.frontiersin.org/article/10.3389/fneur.2020.596382.

Barnett C, Herbelin L, Dimachkie MM, Barohn RJ. Measuring Clinical Treatment Response in Myasthenia Gravis. Neurol Clin. 2018;36(2):339-353. doi:10.1016/j.ncl.2018.01.006

Tuan V, Andreas M, Renato M, et al. Terminal Complement Inhibitor Ravulizumab in Generalized Myasthenia Gravis. NEJM Evid. 2022;1(5):EVIDoa2100066. doi:10.1056/EVIDoa2100066

Muppidi S, Guptill JT, Jacob S, et al. COVID-19-associated risks and effects in myasthenia gravis (CARE-MG). Lancet Neurol. 2020;19(12):970-971. doi:10.1016/S1474-4422(20)30413-0

Roy B, Kovvuru S, Nalleballe K, Onteddu SR, Nowak RJ. Electronic health record derived-impact of COVID-19 on myasthenia gravis. J Neurol Sci. 2021;423:117362. doi:10.1016/j.jns.2021.117362

Digala LP, Prasanna S, Rao P, Qureshi AI, Govindarajan R. Impact of COVID-19 infection among myasthenia gravis patients- a Cerner Real-World DataTM study. BMC Neurol. 2022;22(1):38. doi:10.1186/s12883-022-02564-x

Saied Z, Rachdi A, Thamlaoui S, et al. Myasthenia gravis and COVID-19: A case series and comparison with literature. Acta Neurol Scand. 2021;144(3):334-340. doi:10.1111/ane.13440

Abbas AS, Hardy N, Ghozy S, et al. Characteristics, treatment, and outcomes of Myasthenia Gravis in COVID-19 patients: A systematic review. Clin Neurol Neurosurg. 2022;213:107140. doi:10.1016/j.clineuro.2022.107140

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. doi:10.15585/mmwr.mm6912e2

Jin JM, Bai P, He W, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Heal. 2020;8(April):1-6. doi:10.3389/fpubh.2020.00152

Peckham H, de Gruijter NM, Raine C, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317. doi:10.1038/s41467-020-19741-6

Pivonello R, Auriemma RS, Pivonello C, et al. Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women Stronger? Neuroendocrinology. 2021;111(11):1066-1085. doi:10.1159/000513346

Pisella LI, Fernandes S, Solé G, et al. A multicenter cross-sectional French study of the impact of COVID-19 on neuromuscular diseases. Orphanet J Rare Dis. 2021;16(1):450. doi:10.1186/s13023-021-02090-y

Thomsen JLS, Vinge L, Harbo T, Andersen H. Gender differences in clinical outcomes in myasthenia gravis: A prospective cohort study. Muscle Nerve. 2021;64(5):538-544. doi:https://doi.org/10.1002/mus.27331

Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017

Liu B, Spokes P, He W, Kaldor J. High risk groups for severe COVID-19 in a whole of population cohort in Australia. BMC Infect Dis. 2021;21(1):685. doi:10.1186/s12879-021-06378-z

Jakubíková M, Týblová M, Tesař A, et al. Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival. Eur J Neurol. 2021;28(10):3418-3425. doi:10.1111/ene.14951

Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436

Bradley MC, Perez-Vilar S, Chillarige Y, et al. Systemic Corticosteroid Use for COVID-19 in US Outpatient Settings From April 2020 to August 2021. JAMA. 2022;327(20):2015-2018. doi:10.1001/jama.2022.4877

Wang W, Thomas R, Oh J, Su D-M. Thymic Aging May Be Associated with COVID-19 Pathophysiology in the Elderly. Cells. 2021;10(3). doi:10.3390/cells10030628

Wolfe GI, Kaminski HJ, Sonnett JR, Aban IB, Kuo HC, Cutter GR. Randomized trial of thymectomy in myasthenia gravis. J Thorac Dis. 2016;8(12):E1782-E1783. doi:10.21037/jtd.2016.12.80

Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(11):1393-1399. doi:10.1136/annrheumdis-2020-217984

Faqihi F, Alharthy A, Abdulaziz S, et al. Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial. Int J Antimicrob Agents. 2021;57(5):106334. doi:10.1016/j.ijantimicag.2021.106334

Cao W, Liu X, Bai T, et al. High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019. Open forum Infect Dis. 2020;7(3):ofaa102. doi:10.1093/ofid/ofaa102

Kindgen-Milles D, Feldt T, Jensen BEO, Dimski T, Brandenburger T. Why the application of IVIG might be beneficial in patients with COVID-19. Lancet Respir Med. 2022;10(2):e15. doi:10.1016/S2213-2600(21)00549-X

Mazeraud A, Wolff M, Lucas B, Sharshar T. Why the application of IVIG might be beneficial in patients with COVID-19 - Authors’ reply. Lancet Respir Med. 2022;10(2):e16. doi:10.1016/S2213-2600(21)00550-6

Tagami T, Matsui H, Fushimi K, Yasunaga H. Intravenous Immunoglobulin and Mortality in Pneumonia Patients With Septic Shock: An Observational Nationwide Study. Clin Infect Dis. 2015;61(3):385-392. doi:10.1093/cid/civ307

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Published

2023-09-15

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Section

Clinic and Case Reports

How to Cite

Daif, A., Gapchup, T., & Paul, P. (2023). Clinical Outcomes in COVID-19 patients with pre-existing myasthenia gravis:: A systematic analysis of reported cases. RRNMF Neuromuscular Journal, 4(4). https://doi.org/10.17161/rrnmf.v4i4.20317