In light of the coronavirus disease 2019 (COVID-19) global health crisis, the International Myasthenia Gravis (MG)/COVID-19 Working Group has published a short guidance statement on the management of MG and Lambert-Eaton myasthenic syndrome (LEMS) during this novel pandemic. The guidance statement was published in the Journal of Neurological Sciences.
According to the working group, patients with MG/LEMS may be at a higher risk of contracting COVID-19 and may have more severe symptoms from infection due to the use of immunosuppressive or immunomodulatory therapies to control the disease. Additionally, patients with MG may have respiratory muscle weakness, which can further complicate prognosis if the patient was infected.
In spite of these risks, the International MG/COVID-19 Working Group said in their guidance statement that patients with MG/LEMS should continue their current treatment regimen unless discontinuation has been approved by their healthcare provider. No evidence has linked the use of symptomatic therapies, such as Pyridostigmine or 3,4 Diaminopyridine, with an increased risk of infection. Patients who take immunosuppressive medications should be extra diligent in their social-distancing practices. This includes the use of telehealth consultations whenever possible.
The working group recommends that clinicians consider patients’ regional incidence of COVID-19 when deciding whether a patient should travel to a hospital or an infusion center for MG infusion therapies. Where possible, the clinician should recommend switching to home infusions. Patients with acute exacerbations should be given top priority for plasma exchange and intravenous immunoglobulin (IVIG), but no evidence exists to support the notion that IVIG or therapeutic plasma exchange increases the risk of COVID-19. Patients who are receiving these therapies as maintenance should continue to do so.
The choice to perform routine blood monitoring, such as in the case to monitor therapy, should be made on an individualized approach that is based on a patient’s regional COVID-19 incidence. In patients with MG/LEMS who have contracted the virus, the working group recommends that these patients continue the current best practice standard of care for their disease. In some cases, the dose of corticosteroids might need to be increased.
Clinicians may wish to consider temporarily pausing immunosuppression if the patient becomes infected with the virus, and immune-depleting agents should not be administered in these cases. Treatment with standard immunosuppressive agents, such as azathioprine and mycophenolate, should probably continue, the working group advised.
The working group concluded that “decisions regarding immunotherapy use should be individualized and made by the person with MG and his/her healthcare provider.”
Jacob S, Muppidi S, Guidon A, et al; International MG/COVID-19 Working Group. Guidance for the management of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic. J Neurol Sci. 2020;412:116803.