Myasthenia gravis is a disease of the neuromuscular junction, resulting in excessive muscle fatigue on exertion. Treatment can involve corticosteroids and/or immunosuppressants, medicines that are theoretically risky in the context of the COVID-19 pandemic. Additionally, there is a risk of a severe bout of the disease with respiratory involvement and bulbar weakness (myasthenic crisis) in the event of infectious episode.
The prognosis is becoming clearer, and so are the disease severity factors
In the spring of 2020, twelve centres in the FILNEMUS network started to put together a cohort of patients with myasthenia gravis who had contracted COVID-19. This database, named Co-My-Covid and led by Bordeaux University Hospital, was developed with support from AFM-Téléthon.
According to a retrospective analysis of its data compiled between March and June 2020:
- 34 of the 3558 patients (0.96%) with myasthenia gravis, registered in the French rare diseases database (BNDMR) developed COVID-19, at a mean age of 55 +/– 19.9 years;
- 44.1% were treated at home, 29.4% in medical wards (moderately severe COVID-19) and 26.5% in Intensive Care (severe COVID-19);
- 14.7% of patients died (n=5), not due to decompensation of their myasthenia, but due to acute respiratory distress syndrome associated with COVID-19, either isolated (40%) or in combination with multi-organ failure or bacterial infection;
- 34.5% of survivors experienced a worsening of their disease (including myasthenic crisis), a figure similar to that observed with flu-like syndrome;
- immunosuppressants, alone or in combination with corticosteroid therapy, constituted a risk factor for developing a severe form of COVID-19 in univariate analysis; however, there was no significant correlation with using corticosteroids alone, with the type of myasthenia or even with amount of time the patient had had myasthenia;
- having a severe form of myasthenia (MGFA class ≥ IV) before infection with SARS-CoV-2 was associated with a high risk of developing severe COVID-19 (odds ratio: 102.6).
Co-My-Covid is still currently ongoing…
If you have myasthenic patients who have, or have had, COVID-19, whether proven or suspected, you may contact the investigators by email at: informations-comycovid@chu-bordeaux.fr
… and Va-C-Nemus is starting
The FILNEMUS network also launched the Va-C-Nemus observatory on 10 March 2021. This is an online survey that will conducted over a one-year period, to monitor the COVID-19 pandemic and vaccination. For more information, you may consult the Va-C-Nemus observatory website
