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. 2021 Oct;28(10):3418-3425.
doi: 10.1111/ene.14951. Epub 2021 Jun 25.

Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival

Michala Jakubíková  1 , Michaela Týblová  1 , Adam Tesař  1   2 , Magda Horáková  3   4 , Daniela Vlažná  3   4   5 , Irena Ryšánková  1 , Iveta Nováková  1 , Kristýna Dolečková  1 , Pavel Dušek  1 , Jiří Piťha  1 , Stanislav Voháňka  3   4 , Josef Bednařík  3   4
Affiliations

Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival

Michala Jakubíková et al. Eur J Neurol. 2021 Oct.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] Eur J Neurol. 2022 Feb;29(2):682. doi: 10.1111/ene.15187. Eur J Neurol. 2022. PMID: 35018702 Free PMC article. No abstract available.

Abstract

Background and purpose: Myasthenia gravis (MG) patients could be a vulnerable group in the pandemic era of coronavirus 2019 (COVID-19) mainly due to respiratory muscle weakness, older age and long-term immunosuppressive treatment. We aimed to define factors predicting the severity of COVID-19 in MG patients and risk of MG exacerbation during COVID-19.

Methods: We evaluated clinical features and outcomes after COVID-19 in 93 MG patients.

Results: Thirty-five patients (38%) had severe pneumonia and we recorded 10 deaths (11%) due to COVID-19. Higher forced vital capacity (FVC) values tested before COVID-19 were shown to be protective against severe infection (95% CI 0.934-0.98) as well as good control of MG measured by the quantified myasthenia gravis score (95% CI 1.047-1.232). Long-term chronic corticosteroid treatment worsened the course of COVID-19 in MG patients (95% CI 1.784-111.43) and this impact was positively associated with dosage (p = 0.005). Treatment using azathioprine (95% CI 0.448-2.935), mycophenolate mofetil (95% CI 0.91-12.515) and ciclosporin (95% CI 0.029-2.212) did not influence the course of COVID-19. MG patients treated with rituximab had a high risk of death caused by COVID-19 (95% CI 3.216-383.971). Exacerbation of MG during infection was relatively rare (15%) and was not caused by remdesivir, convalescent plasma or favipiravir (95% CI 0.885-10.87).

Conclusions: As the most important predictors of severe COVID-19 in MG patients we identified unsatisfied condition of MG with lower FVC, previous long-term corticosteroid treatment especially in higher doses, older age, the presence of cancer, and recent rituximab treatment.

Keywords: COVID-19; corticosteroids; immunosuppression; myasthenia gravis; rituximab.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Sigmoid function of logit regression of severe COVID‐19 pneumonia with a histogram for dependence on forced vital capacity (FVC) (%) (left) and dosage of corticosteroids (mg) (right)
FIGURE 2
FIGURE 2
Odds ratio and confidence interval for severe pneumonia for different parameters and in the case of rituximab odds ratio of death for COVID‐19 infection
See this image and copyright information in PMC

Comment in

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