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

J 2021

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

JAKUBIKOVA, Michala, Michaela TYBLOVA, Adam TESAR, Magda HORÁKOVÁ, Daniela VLAŽNÁ et. al.

Basic information

Original name

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

Authors

JAKUBIKOVA, Michala (203 Czech Republic, guarantor), Michaela TYBLOVA (203 Czech Republic), Adam TESAR (203 Czech Republic), Magda HORÁKOVÁ (203 Czech Republic, belonging to the institution), Daniela VLAŽNÁ (703 Slovakia, belonging to the institution), Irena RYSANKOVA (203 Czech Republic), Iveta NOVAKOVA (203 Czech Republic), Kristyna DOLECKOVA (203 Czech Republic), Pavel DUSEK (203 Czech Republic), Jiri PITHA (203 Czech Republic), Stanislav VOHÁŇKA (203 Czech Republic, belonging to the institution) and Josef BEDNAŘÍK (203 Czech Republic, belonging to the institution)

Edition

European Journal of Neurology, Oxford, Rapid Science Ltd. 2021, 1351-5101

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.288

RIV identification code

RIV/00216224:14110/21:00121957

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1111/ene.14951

UT WoS

000665783600001

Keywords in English

corticosteroids; COVID-19; immunosuppression; myasthenia gravis; rituximab

Abstract

V originále

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.

Links

MUNI/A/1600/2020, interní kód MU

Name: Diagnostika a patofyziologie neuropatické bolesti (Acronym: PNB)

Investor: Masaryk University

Citovat

JAKUBIKOVA, Michala, Michaela TYBLOVA, Adam TESAR, Magda HORÁKOVÁ, Daniela VLAŽNÁ, Irena RYSANKOVA, Iveta NOVAKOVA, Kristyna DOLECKOVA, Pavel DUSEK, Jiri PITHA, Stanislav VOHÁŇKA and Josef BEDNAŘÍK. Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival. European Journal of Neurology. Oxford: Rapid Science Ltd., 2021, vol. 28, No 10, p. 3418-3425. ISSN 1351-5101. Available from: https://dx.doi.org/10.1111/ene.14951.

@article{1783118,
   author = {Jakubikova, Michala and Tyblova, Michaela and Tesar, Adam and Horáková, Magda and Vlažná, Daniela and Rysankova, Irena and Novakova, Iveta and Doleckova, Kristyna and Dusek, Pavel and Pitha, Jiri and Voháňka, Stanislav and Bednařík, Josef},
   article_location = {Oxford},
   article_number = {10},
   doi = {http://dx.doi.org/10.1111/ene.14951},
   keywords = {corticosteroids; COVID-19; immunosuppression; myasthenia gravis; rituximab},
   language = {eng},
   issn = {1351-5101},
   journal = {European Journal of Neurology},
   title = {Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival},
   url = {https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.14951},
   volume = {28},
   year = {2021}
}

TY  - JOUR
ID  - 1783118
AU  - Jakubikova, Michala - Tyblova, Michaela - Tesar, Adam - Horáková, Magda - Vlažná, Daniela - Rysankova, Irena - Novakova, Iveta - Doleckova, Kristyna - Dusek, Pavel - Pitha, Jiri - Voháňka, Stanislav - Bednařík, Josef
PY  - 2021
TI  - Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival
JF  - European Journal of Neurology
VL  - 28
IS  - 10
SP  - 3418-3425
EP  - 3418-3425
PB  - Rapid Science Ltd.
SN  - 13515101
KW  - corticosteroids
KW  - COVID-19
KW  - immunosuppression
KW  - myasthenia gravis
KW  - rituximab
UR  - https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.14951
N2  - 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.
ER  -

JAKUBIKOVA, Michala, Michaela TYBLOVA, Adam TESAR, Magda HORÁKOVÁ, Daniela VLAŽNÁ, Irena RYSANKOVA, Iveta NOVAKOVA, Kristyna DOLECKOVA, Pavel DUSEK, Jiri PITHA, Stanislav VOHÁŇKA and Josef BEDNAŘÍK. Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival. \textit{European Journal of Neurology}. Oxford: Rapid Science Ltd., 2021, vol.~28, No~10, p.~3418-3425. ISSN~1351-5101. Available from: https://dx.doi.org/10.1111/ene.14951.

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