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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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Zheng W, Cao X, Luo J, Liu Z, Que W, Guo X, Fan R, Long Q, Xiao F. Safety and neutralization antibody levels of inactivated SARS-CoV-2 vaccine in adult patients with Myasthenia Gravis: a prospective observational cohort study. Neurol Sci 2024; 45:1707-1717. [PMID: 37940750 DOI: 10.1007/s10072-023-07186-w] [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: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction. No cohort study has investigated the efficacy of inactivated vaccines in patients with MG. MATERIALS AND METHODS This prospective observational cohort study included healthy controls (HCs) and patients with MG with or without immunosuppressive treatment. Vaccination occurred between May and December 2021. Patients with MG were subjected to a clinical scale assessment for disease severity. The neutralization antibodies (Nabs) levels were measured in all participants using the pseudovirus neutralization assay. RESULTS Twenty-one patients (Female/Male:10/11); age median [interquartile range (IQR)]: 43 [30, 56]) were included in this study. Two patients (2/21) were lost during follow-up after enrollment. No sustained vaccine-related adverse effects occurred in any visit of patients with MG. No exacerbation of MG was observed. Acetylcholine receptor antibody (AChR-Ab) levels showed no statistically significant changes between the first and second visit (median [IQR]: 2.22 [0.99, 2.63] nmol/L vs. 1.54 [1.07, 2.40] nmol/L, p = 0.424). However, levels of AChR-Ab decreased at the third visit (median [IQR]: 2.22 [0.96, 2.70] nmol/L vs. 1.69 [0.70, 1.85] nmol/L, p = 0.011). No statistically significant difference in Nabs levels was found between HCs and patients with MG (median [IQR]: 102.89 [33.13, 293.86] vs. 79.29 [37.50, 141.93], p = 0.147). DISCUSSION The safety of the SARS-CoV-2 inactivated vaccine was reconfirmed in this study. No significant difference in Nabs level was found between patients with MG and HCs. Nabs levels correlated with AChR-Ab levels before vaccination and ΔAChR-Ab levels.
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Affiliation(s)
- Wei Zheng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xiaoxia Cao
- Key Laboratory of Molecular Biology On Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jing Luo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Zhuoting Liu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Wenjun Que
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
- Department of Blood Transfusion, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Guo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
- Department of Neurology, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Rui Fan
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Quanxin Long
- Key Laboratory of Molecular Biology On Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
| | - Fei Xiao
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China.
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Ning F, Cao XQ, Wang QQ, Li ZY, Ruan Z, Chang T. Safety of SARS-CoV-2 vaccine in patients with autoimmune neurological conditions: A systematic review and meta-analysis. Heliyon 2024; 10:e23944. [PMID: 38261862 PMCID: PMC10796982 DOI: 10.1016/j.heliyon.2023.e23944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Risk of adverse effects and exacerbation in autoimmune neurological conditions (ANC)are frequently cited reasons for COVID-19 vaccine hesitancy. This study evaluates the ANC safety of COVID-19 vaccines in the real world. Methods Electronic databases were searched to identify studies reporting the use of the COVID-19 vaccine in ANC. We selected studies that provided data on adverse effects and worsening conditions related to ANC after vaccination. The pooled incidence rates for various adverse effects, stratified for the disease category, dosage, and type of vaccine, were estimated. Results Twenty-eight studies (31 vaccination cohorts) were included. The pooled incidence rate of general adverse events was 0.35 (95%CI, 0.27-0.43, I2 = 100 %). The pooled incidence rates of local injection reaction, fatigue, weakness, myalgia, fever, headache, and chills were 0.27 (0.18-0.36, I2 = 98 %), 0.16(0.11-0.21, I2 = 93 %), 0.15(0.00-0.31, I2 = 97 %), 0.13(0.08-0.19, I2 = 97 %), 0.11(0.07-0.15, I2 = 95 %), 0.11(0.07-0.16, I2 = 97 %), and 0.09 (0.03-0.16, I2 = 96 %), respectively. The pooled incidence rate of exacerbation adverse events was 0.05 (95%CI, 0.04-0.07, I2 = 84 %). Conclusion According to available evidence, the administration of COVID-19 vaccines in individuals with autoimmune neurological disorders seems well-tolerated, with few reports of adverse events. Furthermore, exacerbation of autoimmune neurological conditions following vaccination appears to be infrequent.
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Affiliation(s)
| | | | - Qing-qing Wang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhu-yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
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Zheng Q, Cheng Y, Song C, Feng Z, Xu Z. Safety of SARS-CoV-2 vaccines in patients with myasthenia gravis: a meta-analysis. Neurol Sci 2023; 44:2999-3003. [PMID: 37243794 PMCID: PMC10224648 DOI: 10.1007/s10072-023-06875-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Qian Zheng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Chengxin Song
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Zucai Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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Ruan Z, Huan X, Su Y, Tang YL, Meng DD, Ren DL, Li CH, Hao SJ, Zhao CB, Luo SS, Li ZY, Chang T. Safety of COVID-19 vaccine in patients with myasthenia gravis: a self-controlled case series study. Front Immunol 2023; 14:1141983. [PMID: 37223097 PMCID: PMC10200982 DOI: 10.3389/fimmu.2023.1141983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
Background The safety of COVID-19 vaccines has been clarified in clinical trials; however, some immunocompromised patients, such as myasthenia gravis (MG) patients, are still hesitant to receive vaccines. Whether COVID-19 vaccination increases the risk of disease worsening in these patients remains unknown. This study aims to evaluate the risk of disease exacerbation in COVID-19-vaccinated MG patients. Methods The data in this study were collected from the MG database at Tangdu Hospital, the Fourth Military Medical University, and the Tertiary Referral Diagnostic Center at Huashan Hospital, Fudan University, from 1 April 2022 to 31 October 2022. A self-controlled case series method was applied, and the incidence rate ratios were calculated in the prespecified risk period using conditional Poisson regression. Results Inactivated COVID-19 vaccines did not increase the risk of disease exacerbation in MG patients with stable disease status. A few patients experienced transient disease worsening, but the symptoms were mild. It is noted that more attention should be paid to thymoma-related MG, especially within 1 week after COVID-19 vaccination. Conclusion COVID-19 vaccination has no long-term impact on MG relapse.
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Affiliation(s)
- Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xiao Huan
- Huashan Rare Disease Center, Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Yue Su
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yong-Lan Tang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Dong-Dong Meng
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Da-Lin Ren
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chun-Hong Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Si-Jia Hao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chong-Bo Zhao
- Huashan Rare Disease Center, Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Su-Shan Luo
- Huashan Rare Disease Center, Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Zhu-Yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
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COVID-19 vaccination in myasthenia gravis: safe, but predictors of disease exacerbation yet to be determined. Neurol Sci 2023; 44:1503-1504. [PMID: 36808584 PMCID: PMC9938504 DOI: 10.1007/s10072-023-06694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
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Virgilio E, Tondo G, Montabone C, Comi C. COVID-19 Vaccination and Late-Onset Myasthenia Gravis: A New Case Report and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010467. [PMID: 36612789 PMCID: PMC9819717 DOI: 10.3390/ijerph20010467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 05/20/2023]
Abstract
Myasthenia gravis (MG) is a rare autoimmune disease that is potentially threatening for patient life. Auto-antibodies targeting structures of the neuromuscular junction, particularly the acetylcholine receptor (AchR), are often found in the serum of MG patients. New-onset MG after SARS-CoV-2 vaccination has rarely been reported since the introduction of vaccination. Infections and COVID-19 infection have also been reported as possible triggers for a myasthenic crisis. We report a case of new-onset MG after receiving the mRNA COVID-19 vaccination. The patient was a 73-year-old male initially presenting with ocular symptoms and a rapid generalization. We also performed a literature revision of 26 described cases of MG after SARS-CoV-2 immunization. The patients were a majority of males with generalized late-onset MG occurring after the first dose of vaccine, similar to our patient. Only our patient showed a thymoma. Thymic mass and the positivity of AchR antibodies suggest that vaccination might have triggered a subclinical pre-existing MG with symptoms flaring. Clinicians should be aware of possible new-onset MG after COVID-19 vaccination, particularly in at-risk patients. Even though COVID-19 vaccination should be recommended in MG patients, particularly in well-compensated patients. However, more studies need to be performed in the future.
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Affiliation(s)
- Eleonora Virgilio
- Department of Translational Medicine, Section of Neurology, University of Eastern Piedmont, 28100 Novara, Italy
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Claudia Montabone
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy
- Correspondence:
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Peng S, Tian Y, Meng L, Fang R, Chang W, Yang Y, Li S, Shen Q, Ni J, Zhu W. The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review. Front Immunol 2022; 13:1103020. [PMID: 36618419 PMCID: PMC9812949 DOI: 10.3389/fimmu.2022.1103020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 vaccines are required for individuals with myasthenia gravis (MG), as these patients are more likely to experience severe pneumonia, myasthenia crises, and higher mortality rate. However, direct data on the safety of COVID-19 vaccines in patients with MG are lacking, which results in hesitation in vaccination. This scoping was conducted to collect and summarize the existing evidence on this issue. Methods PubMed, Cochrane Library, and Web of Science were searched for studies using inclusion and exclusion criteria. Article titles, authors, study designs, demographics of patients, vaccination information, adverse events (AEs), significant findings, and conclusions of included studies were recorded and summarized. Results Twenty-nine studies conducted in 16 different countries in 2021 and 2022 were included. Study designs included case report, case series, cohort study, cross-sectional study, survey-based study, chart review, and systemic review. A total of 1347 patients were included. The vaccines used included BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, inactivated vaccines, and recombinant subunit vaccines. Fifteen case studies included 48 patients reported that 23 experienced new-onset, and five patients experienced flare of symptoms. Eleven other types of studies included 1299 patients reported that nine patients experienced new-onset, and 60 participants experienced flare of symptoms. Common AEs included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia. Most patients responded well to treatment without severe sequelae. Evidence gaps include limited strength of study designs, type and dose of vaccines varied, inconsistent window of risk and exacerbation criteria, limited number of participants, and lack of efficacy evaluation. Conclusion COVID-19 vaccines may cause new-onset or worsening of MG in a small proportion of population. Large-scale, multicenter, prospective, and rigorous studies are required to verify their safety.
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Affiliation(s)
- Siyang Peng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yukun Tian
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linghao Meng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruiying Fang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiqian Chang
- Department of Acupuncture, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine Ji’nan Hospital (Ji’nan Hospital of Traditional Chinese Medicine), Shandong, China
| | - Yajing Yang
- Department of Traditional Chinese Medicine, Yuyuantan Community Health Center, Beijing, China
| | - Shaohong Li
- Treatment Center of Traditional Chinese Medicine, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- Treatment Center of Traditional Chinese Medicine, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Qiqi Shen
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinxia Ni
- Department of Acupuncture, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenzeng Zhu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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