COVID-19 Infection and Myasthenia Gravis Outcomes: How Do Patients Fare?

There is insufficient evidence to support the notion that COVID-19 worsens outcomes of myasthenia gravis (MG), according to a systematic review and meta-analysis published in Clinical Neurology and Neurosurgery.

Patients with MG are prone to infection. COVID-19 is of particular concern as MG is associated with respiratory muscle weakness and the fact that typical treatments for COVID-19 have been found to exacerbate MG symptoms. Recent reports have indicated that COVID-19 infection rates are elevated among the population of patients with neuromuscular disorders, however, the outcomes of COVID-19 among patients with MG has not been well characterized.

The objective of the current study was to assess the outcomes of invasive ventilation, mortality, and hospital length of stay among patients presenting with MG and COVID-19.

For this study, publication databases were searched through October 2021 for studies of COVID-19 among patients with MG. Included patients (N=152) from 19 studies were aged mean 54.4±12.7 years, 52.0% were women, 38.0% had undergone thymomectomy, and 12.8% had no comorbidities. The incidence of COVID-19 stratified by age was 0.0% for patients aged 10-19 years, 25.4% for 20-39 years, 33.9% for 40-59 years, and 40.7% for ³60 years.

The most common treatments for COVID-19 were azithromycin (37.3%) and ceftriaxone (32.2%). Other treatments included hydroxychloroquine, lopinavir-ritonavir, oseltamivir, tocilizumab, tazobactam/piperacillin, meropenem, and heparin. After COVID-19, most patients received prednisone/corticosteroids (62.7%).

Most patients received invasive ventilation (42.4%) or non-invasive ventilation (28.8%). The average hospital stay was 18.2±9.9 days.

Most patients survived (88.2%). Fewer patients who had undergone thymomectomy died (5.0% vs 17.2%).

This analysis was limited as most of the included studies were case studies or case reports and the researchers did not perform a formal bias risk assessment.

The study authors concluded, “This report provides an overview of the characteristics, treatment, and outcomes of MG in COVID-19 patients. Although COVID-19 may exaggerate the neurological symptoms and worsens the outcome in MG patients, we did not find enough evidence to support this notion. Further studies with larger numbers of patients with MG and COVID-19 are needed to better assess the clinical outcomes in these patients, relative to outcomes in patients with COVID-19 only.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

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. Published online January 22, 2022. doi:10.1016/j.clineuro.2022.107140