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Jiang Y, Wang J, Su S, Zhang S, Wen Q, Wang Y, Li L, Han J, Xie N, Liu H, Sun Y, Lu Y, Di L, Wang M, Xu M, Chen H, Wang S, Wen X, Zhu W, Da Y. The Impact of COVID-19 Vaccination and Infection on the Exacerbation of Myasthenia Gravis. Vaccines (Basel) 2024; 12:1221. [PMID: 39591124 PMCID: PMC11598725 DOI: 10.3390/vaccines12111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/20/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
OBJECTIVES Myasthenia Gravis (MG) is an autoimmune disorder that can exacerbate for various reasons, including vaccination and infection. This study aimed to investigate the safety of COVID-19 vaccines for MG patients, factors influencing MG exacerbation after COVID-19 infection (MECI), the course and prognosis of MECI, and the impact of COVID-19 vaccine on infected MG patients. METHODS Patients were enrolled from the MG database in the Department of Neurology, Xuanwu Hospital, Capital Medical University. Two questionnaires were administered to collect data concerning COVID-19 vaccination (questionnaire 1, Q1) and infection (questionnaire 2, Q2) during two distinct periods. MG exacerbation was defined as an increase of at least two points in the MG activity of daily living (MG-ADL) score. COVID-19 severity was categorized as "hospitalization" or "home management"; Results: During the first data-collecting period, our database registered 1013 adult patients: 273 (26.9%) had received COVID-19 vaccinations and completed Q1, and 8 (2.9%) experienced MG exacerbation after vaccination. During the second data-collecting period, among the newly registered patients, 366 patients completed Q2. Of these, 244 were infected, with 39 (16.0%) experiencing MECI and 21 (8.6%) requiring hospitalization. Multivariate analysis showed that generalized myasthenia gravis was associated with MECI (OR 3.354, 95% CI: 1.423-7.908, p = 0.006). Among the 244 infected patients, 143 had received COVID-19 vaccinations, including 14 who received their booster dose within 6 months before COVID-19 and 129 who were vaccinated more than 6 months before COVID-19. The remaining 101 were unvaccinated. No significant associations were found between COVID-19 vaccination and COVID-19 severity (p = 0.292) or MECI incidence (p = 0.478); Conclusions: COVID-19 vaccines were found to be safe for MG patients in stable condition. Patients with gMG were more susceptible to experiencing MECI. No significant impact of the vaccine on COVID-19 severity or MECI incidence was observed.
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Affiliation(s)
- Yuting Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Jingsi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shengyao Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shu Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Qi Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yaye Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Ling Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Tianjin 4th Centre Hospital, Tianjin 300140, China
| | - Jianxin Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing 102401, China
| | - Nairong Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Haoran Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yanan Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian 116001, China
| | - Yan Lu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Li Di
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Suobin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Xinmei Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Wenjia Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yuwei Da
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
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Zhang N, Wang Z, Sun D, Chen H, Zhou H. The Risk of Exacerbation of Myasthenia Gravis After COVID-19 Omicron Infection. Brain Behav 2024; 14:e70074. [PMID: 39428557 PMCID: PMC11491296 DOI: 10.1002/brb3.70074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/30/2024] [Accepted: 09/08/2024] [Indexed: 10/22/2024] Open
Abstract
OBJECTIVE The aim of this study is to ascertain whether COVID-19 Omicron infection is associated with exacerbations in these myasthenia gravis (MG) patients. RESULT In total, 289 MG patients (comprising 60% females, with an average age of 46 ± 15 years) were enrolled. A total of 80.9% of MG patients reported a COVID-19 infection, with the majority experiencing a benign course (88%). MG patients who experienced COVID-19 infection demonstrated a higher likelihood of MG exacerbation, compared to those without the infection (18.8% vs. 7.3%, p = 0.039). In the survival analysis, after adjusting for confounding factors, the hazard ratio (HR) for exacerbation post-infection was found to be 3.38 (95% CI 1.20-9.53, p = 0.021). Compared to the exacerbation rates observed in JTA21, an increase was noted in DTM23 among COVID-19-infected MG patients (4.4% vs. 17.2%, p < 0.001). CONCLUSION The COVID-19 is the risk of MG exacerbation.
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Affiliation(s)
- Nana Zhang
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuan ProvincePR China
| | - Ziya Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuan ProvincePR China
| | - Dongren Sun
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuan ProvincePR China
| | - Hongxi Chen
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuan ProvincePR China
| | - Hongyu Zhou
- Department of Neurology, West China HospitalSichuan UniversityChengduSichuan ProvincePR China
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Li J, Zheng Y, Zhao Y, Qi K, Lin G, Liu R, Hao H, Wang Z, Yuan Y, Gao F. COVID-19 in patients with myasthenia gravis: a single-center retrospective study in China. Neurol Sci 2024; 45:2969-2976. [PMID: 38652194 DOI: 10.1007/s10072-024-07518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been a great concern since 2019. Patients with myasthenia gravis (MG) may be at higher risk of COVID-19 and a more severe disease course. We examined the associations between COVID-19 and MG. METHODS This single-center retrospective cohort study involved 134 patients who were diagnosed with MG from June 2020 to November 2022 and followed up until April 2023. They were divided into a COVID-19 group and non-COVID-19 group. Logistic regression analysis was used to detect factors potentially associating COVID-19 with MG. RESULTS Of the 134 patients with MG, 108 (80.6%) had COVID-19. A higher number of comorbidities was significantly associated with an increased risk of COVID-19 (p = 0.040). A total of 103 patients (95.4%) had mild/moderate COVID-19 symptoms, and 4 patients (3.7%) were severe/critical symptoms (including 2 deaths). Higher age (p = 0.036), use of rituximab (p = 0.037), tumors other than thymoma (p = 0.031), Hashimoto's thyroiditis (p = 0.011), more comorbidities (p = 0.002), and a higher baseline MG activities of daily living (MG-ADL) score (p = 0.006) were risk factors for severe COVID-19 symptoms. The MG-ADL score increased by ≥ 2 points in 16 (15.7%) patients. Dry cough and/or expectoration (p = 0.011), use of oral corticosteroids (p = 0.033), and use of more than one kind of immunosuppressant (p = 0.017) were associated with the increase of the post-COVID-19 MG-ADL score. CONCLUSION Most patients with MG have a mild course of COVID-19. However, patients with older age, many comorbidities, a high MG-ADL score, and use of a variety of immunosuppressants during COVID-19 may be more prone to severe symptoms.
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Affiliation(s)
- Jiayi Li
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yiming Zheng
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yawen Zhao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Kang Qi
- Department of Thoracic Surgery, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Gang Lin
- Department of Thoracic Surgery, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ran Liu
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hongjun Hao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhaoxia Wang
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yun Yuan
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Feng Gao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Han HJ, Kim SW, Kim H, So J, Lee EJ, Lim YM, Lee JH, Lee MA, Kim BJ, Baek SH, Lee HS, Sohn E, Kim S, Park JS, Kang M, Park HJ, Yoon BA, Kim JK, Seok HY, Kim S, Min JH, Chung YH, Cho JH, Kim JE, Oh SI, Shin HY. Impact of COVID-19 Infection and Its Association With Previous Vaccination in Patients With Myasthenia Gravis in Korea: A Multicenter Retrospective Study. J Korean Med Sci 2024; 39:e150. [PMID: 38742290 PMCID: PMC11091230 DOI: 10.3346/jkms.2024.39.e150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, patients with myasthenia gravis (MG) were more susceptible to poor outcomes owing to respiratory muscle weakness and immunotherapy. Several studies conducted in the early stages of the COVID-19 pandemic reported higher mortality in patients with MG compared to the general population. This study aimed to investigate the clinical course and prognosis of COVID-19 in patients with MG and to compare these parameters between vaccinated and unvaccinated patients in South Korea. METHODS This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients. RESULTS Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients. CONCLUSION This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.
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Affiliation(s)
- Hee Jo Han
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungmin So
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Lee
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Ah Lee
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Hyung-Soo Lee
- Department of Neurology, National Medical Center, Seoul, Korea
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sooyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin-Sung Park
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Minsung Kang
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyung Jun Park
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeol-A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Hung Youl Seok
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Sohyeon Kim
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hee Cho
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jee-Eun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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Arbel A, Bishara H, Barnett-Griness O, Cohen S, Najjar-Debbiny R, Gronich N, Auriel E, Saliba W. Association between COVID-19 vaccination and myasthenia gravis: A population-based, nested case-control study. Eur J Neurol 2023; 30:3868-3876. [PMID: 37552795 DOI: 10.1111/ene.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/09/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Existing data regarding the link between COVID-19 vaccine and myasthenia gravis (MG) are scarce. We aimed to assess the association between Pfizer-BioNTech vaccine with both new-onset MG and MG exacerbation. METHODS For the first aim, we conducted a nested case-control study in a cohort of 3,052,467 adults, without a diagnosis of MG, from the largest healthcare provider in Israel. Subjects were followed from January 1, 2021 until June 30, 2022 for the occurrence of MG. Ten randomly selected controls were matched to each case of new-onset MG on age and sex. For the second aim, a nested case-control study was conducted in a cohort of 1446 MG patients. Four randomly selected MG patients (controls) were matched to each case of MG exacerbation. Exposure to COVID-19 vaccine in the prior 4 weeks was assessed in cases and controls. RESULTS Overall, 332 patients had new-onset MG and were matched with 3320 controls. Multivariable conditional logistic regression models showed that the odds ratio (OR) for new-onset MG, associated with COVID-19 vaccine, was 1.14 (95% CI 0.73-1.78). The results were consistent in sensitivity analysis that used more stringent criteria to define MG. Overall, 62 patients with MG exacerbation were matched to 248 MG controls. The multivariable OR for MG exacerbation, associated with COVID-19 vaccine, was 1.35 (95% CI 0.37-4.89). All results were similar when the prior exposure to COVID-19 vaccine was extended to 8 weeks. CONCLUSION This study suggests that Pfizer-BioNTech vaccine is not associated with increased risk of new-onset nor exacerbation of MG.
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Affiliation(s)
- Anat Arbel
- Department of Internal Medicine B, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Haya Bishara
- Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ofra Barnett-Griness
- Statistical Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Shai Cohen
- Department of Internal Medicine B, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronza Najjar-Debbiny
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Infection Control and Prevention Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Naomi Gronich
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Eitan Auriel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- Translational Epidemiology Unit and Research Authority, Lady Davis Carmel Medical Center, Haifa, Israel
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Sun D, Tu L, Wang X, Du Q, Wang R, Shi Z, Chen H, Zhou H. Association between COVID-19 and myasthenia gravis (MG): A genetic correlation and Mendelian randomization study. Brain Behav 2023; 13:e3239. [PMID: 37638499 PMCID: PMC10636397 DOI: 10.1002/brb3.3239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Observational studies have suggested an association between coronavirus disease 2019 (COVID-19) and myasthenia gravis (MG). Here, we aimed to estimate the genetic correlation and causal relationship between COVID-19 susceptibility, hospitalization, severity, and MG phenotypes using linkage disequilibrium score regression (LDSC) and Mendelian randomization (MR) approach. METHODS Summary statistics of COVID-19 susceptibility, hospitalization, and severity were used as instrumental variables for exposure traits. Large-scale genome-wide association study (GWAS) data for MG were used as outcome traits. The inverse variance weighted approach was used for the main MR analysis, complemented by MR-Egger, weighted median, simple mode, and weighted mode methods. Sensitivity analysis was implemented using Cochran's Q test, MR-PRESSO method, and MR-Egger intercept test. RESULTS LDSC analysis did not reveal any genetic correlation among COVID-19 susceptibility, hospitalization, severity, and MG phenotypes, including MG, early-onset MG, and late-onset MG (p > .05). Our MR analysis did not provide evidence supporting a causal effect of COVID-19 susceptibility, hospitalization, or severity on MG phenotypes (p > .05). Extensive sensitivity analysis strengthened the robustness and consistency of the MR estimates. CONCLUSION Our study did not find evidence of a genetic correlation or causal relationship among COVID-19 susceptibility, hospitalization, severity, and MG. Future studies with more GWAS data are needed to evaluate the association between COVID-19 phenotypes and MG and its subgroups.
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Affiliation(s)
- Dongren Sun
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Liangdan Tu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Xiaofei Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Qin Du
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Rui Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Ziyan Shi
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hongxi Chen
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
| | - Hongyu Zhou
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduSichuanChina
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Zhou S, Wen Y, Liu C, Zhong J, Liang M, Wu Y, Lv S, Gong Z, Lao D, Li T, Lu T, Tang J, Mo X, Huang W. Clinical Characteristics of Myasthenia Gravis Patients with COVID-19 in Guangxi, China: A Case-Control Study. J Inflamm Res 2023; 16:3157-3168. [PMID: 37525635 PMCID: PMC10387240 DOI: 10.2147/jir.s419307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023] Open
Abstract
Purpose With the adjustment of prevention strategies in December 2022, coronavirus disease 2019 (COVID-19) became widely prevalent in China. This study is aimed to describe the clinical characteristics of myasthenia gravis (MG) patients with COVID-19 and identify risk factors of exacerbation in MG patients with COVID-19 in Guangxi. Patients and Methods A total of 489 MG patients and 587 control subjects in Guangxi during the COVID-19 pandemic were enrolled in this case-control study. After contacting the participants, the clinical data of MG patients and the control group were analyzed. The clinical characteristics of MG patients with COVID-19 were described. Multivariable logistic regression analysis was used for discovering independent risk factors of MG exacerbation in the patients with MG and COVID-19. Results A total of 311 (75.30%) MG patients and 428 (72.91%) control subjects were infected with COVID-19, and 64.31% of MG patients with COVID-19 were women. The median age at the time of interview was 41 (IQR: 28, 54) years old, and median onset age was 36 (IQR: 24, 51), both of which were lower than those in MG patients without COVID-19. MG duration was 24 (IQR: 9, 72) months. About 44.69% of patients were generalized MG (GMG). About 11.90% of MG patients with COVID-19 showed severe COVID-19 symptoms and the duration of symptomatic COVID-19 was 9.57 ± 6.79 days, higher than those in the control group. About 35.69% MG patients with immunosuppressive drugs were infected with COVID-19, which is higher than those in the non-infected MG patients (21.57%). A total of 120 (38.59%) MG patients with COVID-19 had comorbidities. About 21 (20.19%) of the 104 MG patients without vaccination showed severe COVID-19 symptoms. Multivariable logistic regression analysis showed that baseline MG activities of daily living profile (MG-ADL, OR 1.280, 95% CI: 1.010-1.621, p = 0.041), duration of COVID-19 (OR 1.158, 95% CI: 1.100-1.220, p < 0.001), GMG (OR 2.331, 95% CI: 1.228, 4.426, p = 0.010), and lack of COVID vaccination (OR 2.075, 95% CI: 1.152, 3.738, p = 0.015) were independent factors of exacerbation in MG patients with COVID-19. Conclusion MG patients with immunosuppressive drugs, younger onset, longer MG duration, or comorbidities are more susceptible to COVID-19. The baseline MG-ADL, duration of symptomatic COVID-19, GMG, and lack of COVID-19 vaccination are independent risk factors of exacerbation in MG patients with COVID-19.
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Affiliation(s)
- Shaodan Zhou
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yishuang Wen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Chao Liu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Jian Zhong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Manli Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yu Wu
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sirao Lv
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Zhuowei Gong
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Dayuan Lao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Taiyan Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Ting Lu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Jingqun Tang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Xuean Mo
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Wen Huang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
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Gabralla TYI, Bashir HAA, Hajahmed Mohamed OA. Myasthenia Gravis Exacerbation Following COVID-19 Vaccine: A Case Report. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2023.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Vaccination remains the mainstay of strategy for prevention of Coronavirus Disease-2019 (COVID-19). AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by the WHO in mid-February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure.
The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her normally well-controlled MG following her second dose of AZD1222 vaccination. She continued to deteriorate and was admitted to the intensive care unit, where she was intubated and placed on a mechanical ventilator. The low-income setting was a major barrier in obtaining intravenous immunoglobulin until the patient died. Our study aims to present an MG case with features of MG exacerbation following administration of a second dose of AZD1222.
Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. In our case, an exacerbation of MG may have been precipitated by the COVID-19 AstraZeneca vaccine. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients
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