Guilhem Solé1, Stéphane Mathis2, Diane Friedman2, Emmanuelle Salort-Campana2, Céline Tard2, Françoise Bouhour2, Armelle Magot2, Djillali Annane2, Bernard Clair2, Gwendal Le Masson2, Antoine Soulages2, Fanny Duval2, Louis Carla2, Marie-Hélène Violleau2, Tiphaine Saulnier2, Sandrine Segovia-Kueny2, Léa Kern2, Jean-Christophe Antoine2, Guillemette Beaudonnet2, Frédérique Audic2, Laurent Kremer2, Jean-Baptiste Chanson2, Aleksandra Nadaj-Pakleza2, Tanya Stojkovic2, Pascal Cintas2, Marco Spinazzi2, Alexandra Foubert-Samier2, Shahram Attarian2. 1. From the Referral Center for Neuromuscular Diseases AOC (G.S., S.M., G.L.M., A.S., F.D., L.C., M.-H.V.) and ALS Center (S.M., G.L.M., A.S., L.C.), Nerve-Muscle Unit, University Hospitals of Bordeaux (Pellegrin Hospital), University of Bordeaux; Department of Intensive Care (D.F., D.A., B.C.), Raymond Poincare University Hospital, Garches; Referral Center for Neuromuscular Diseases and ALS (E.S.-C., S.A.) and Referral Center for Neuromuscular Diseases, Neuropediatric Unit (F.A.), Timone University Hospital, Aix-Marseille University, Marseille; Department of Neurology, Referral Center for Neuromuscular Diseases (C.T.), University Hospitals of Lille; ENMG Unit, Referral Center for Neuromuscular Diseases (F.B.), University Hospitals of Lyon (Neurologic Hospital Pierre Wertheimer); Referral Center for Neuromuscular Diseases (A.M.), University Hospitals of Nantes; Inserm, UMR1219 (T.S., A.F.-S.), Bordeaux Population Health Research Center, ISPED, University of Bordeaux; Neurodegenerative Diseases Institute, French Reference Centre for MSA (T.S., A.F.-S.), University Hospitals of Bordeaux; AFM-Téléthon (S.S.-K.), Evry; Department of Neurology (L.K.), General Hospital of Le Mans; Department of Neurology (J.-C.A.), University Hospital of Saint-Etienne; Clinical Neurophysiology and Epileptology Department (G.B.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Neurology Department (L.K., J.-B.C., A.N.-P.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," University Hospitals of Strasbourg; APHP (Pitié-Salpêtrière Hospital) (T.S.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," Sorbonne University, Paris; Referral Center for Neuromuscular Diseases, Department of Neurology (P.C.), University Hospitals of Toulouse (Purpan Hospital); and Referral Center for Neuromuscular Diseases, Department of Neurology (M.S.), University Hospital of Angers, France. guilhem.sole@chu-bordeaux.fr. 2. From the Referral Center for Neuromuscular Diseases AOC (G.S., S.M., G.L.M., A.S., F.D., L.C., M.-H.V.) and ALS Center (S.M., G.L.M., A.S., L.C.), Nerve-Muscle Unit, University Hospitals of Bordeaux (Pellegrin Hospital), University of Bordeaux; Department of Intensive Care (D.F., D.A., B.C.), Raymond Poincare University Hospital, Garches; Referral Center for Neuromuscular Diseases and ALS (E.S.-C., S.A.) and Referral Center for Neuromuscular Diseases, Neuropediatric Unit (F.A.), Timone University Hospital, Aix-Marseille University, Marseille; Department of Neurology, Referral Center for Neuromuscular Diseases (C.T.), University Hospitals of Lille; ENMG Unit, Referral Center for Neuromuscular Diseases (F.B.), University Hospitals of Lyon (Neurologic Hospital Pierre Wertheimer); Referral Center for Neuromuscular Diseases (A.M.), University Hospitals of Nantes; Inserm, UMR1219 (T.S., A.F.-S.), Bordeaux Population Health Research Center, ISPED, University of Bordeaux; Neurodegenerative Diseases Institute, French Reference Centre for MSA (T.S., A.F.-S.), University Hospitals of Bordeaux; AFM-Téléthon (S.S.-K.), Evry; Department of Neurology (L.K.), General Hospital of Le Mans; Department of Neurology (J.-C.A.), University Hospital of Saint-Etienne; Clinical Neurophysiology and Epileptology Department (G.B.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Neurology Department (L.K., J.-B.C., A.N.-P.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," University Hospitals of Strasbourg; APHP (Pitié-Salpêtrière Hospital) (T.S.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," Sorbonne University, Paris; Referral Center for Neuromuscular Diseases, Department of Neurology (P.C.), University Hospitals of Toulouse (Purpan Hospital); and Referral Center for Neuromuscular Diseases, Department of Neurology (M.S.), University Hospital of Angers, France.
Abstract
OBJECTIVE: To describe the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) among patients with myasthenia gravis (MG) and identify factors associated with COVID-19 severity in patients with MG. METHODS: The CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS (Filière Neuromusculaire) network (between March 1, 2020, and June 8, 2020), including patients with MG with a confirmed or highly suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a PCR test from a nasopharyngeal swab or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology, thoracic CT scan, or typical symptoms. The main outcome was COVID-19 severity based on location of treatment/management (home, hospitalized in a medical unit, or in an intensive care unit). We collected information on demographic variables, general history, and risk factors for severe COVID-19. Multivariate ordinal regression models were used to identify factors associated with severe COVID-19 outcomes. RESULTS: Among 3,558 patients with MG registered in the French database for rare disorders, 34 (0.96%) had COVID-19. The mean age at COVID-19 onset was 55.0 ± 19.9 years (mean MG duration: 8.5 ± 8.5 years). By the end of the study period, 28 patients recovered from COVID-19, 1 remained affected, and 5 died. Only high Myasthenia Gravis Foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 (p = 0.004); factors that were not associated included sex, MG duration, and medium MGFA classes (≤IIIb). The type of MG treatment had no independent effect on COVID-19 severity. CONCLUSIONS: This registry-based cohort study shows that COVID-19 had a limited effect on most patients, and immunosuppressive medications and corticosteroids used for MG management are not risk factors for poorer outcomes. However, the risk of severe COVID-19 is elevated in patients with high MGFA classes (odds ratio, 102.6 [4.4-2,371.9]). These results are important for establishing evidence-based guidelines for the management of patients with MG during the COVID-19 pandemic.
OBJECTIVE: To describe the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) among patients with myasthenia gravis (MG) and identify factors associated with COVID-19 severity in patients with MG. METHODS: The CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS (Filière Neuromusculaire) network (between March 1, 2020, and June 8, 2020), including patients with MG with a confirmed or highly suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a PCR test from a nasopharyngeal swab or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology, thoracic CT scan, or typical symptoms. The main outcome was COVID-19 severity based on location of treatment/management (home, hospitalized in a medical unit, or in an intensive care unit). We collected information on demographic variables, general history, and risk factors for severe COVID-19. Multivariate ordinal regression models were used to identify factors associated with severe COVID-19 outcomes. RESULTS: Among 3,558 patients with MG registered in the French database for rare disorders, 34 (0.96%) had COVID-19. The mean age at COVID-19 onset was 55.0 ± 19.9 years (mean MG duration: 8.5 ± 8.5 years). By the end of the study period, 28 patients recovered from COVID-19, 1 remained affected, and 5 died. Only high Myasthenia Gravis Foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 (p = 0.004); factors that were not associated included sex, MG duration, and medium MGFA classes (≤IIIb). The type of MG treatment had no independent effect on COVID-19 severity. CONCLUSIONS: This registry-based cohort study shows that COVID-19 had a limited effect on most patients, and immunosuppressive medications and corticosteroids used for MG management are not risk factors for poorer outcomes. However, the risk of severe COVID-19 is elevated in patients with high MGFA classes (odds ratio, 102.6 [4.4-2,371.9]). These results are important for establishing evidence-based guidelines for the management of patients with MG during the COVID-19 pandemic.
Authors: Frauke Stascheit; Ulrike Grittner; Sarah Hoffmann; Philipp Mergenthaler; Michael Schroeter; Tobias Ruck; Mark Pawlitzki; Franz Blaes; Julia Kaiser; Ulrike Schara; Adela Della-Marina; Andrea Thieme; Tim Hagenacker; Christian Jacobi; Benjamin Berger; Peter P Urban; Karl Christian Knop; Berthold Schalke; De-Hyung Lee; Petra Kalischewski; Heinz Wiendl; Andreas Meisel Journal: J Neurol Date: 2022-09-27 Impact factor: 6.682