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Neurology . Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis

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  • Neurology . Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis


    . 2021 Feb 10;10.1212/WNL.0000000000011669.
    doi: 10.1212/WNL.0000000000011669. Online ahead of print.
    Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis

    Guilhem Sol? 1 , St?phane Mathis 2 3 , Diane Friedman 4 , Emmanuelle Salort-Campana 5 , C?line Tard 6 , Fran?oise Bouhour 7 , Armelle Magot 8 , Djillali Annane 4 , Bernard Clair 4 , Gwendal Le Masson 2 3 , Antoine Soulages 2 3 , Fanny Duval 2 , Louis Carla 2 3 , Marie-H?l?ne Violleau 2 , Tiphaine Saulnier 9 10 , Sandrine Segovia-Kueny 11 , L?a Kern 12 , Jean-Christophe Antoine 13 , Guillemette Beaudonnet 14 , Fr?d?rique Audic 15 , Laurent Kremer 16 , Jean-Baptiste Chanson 16 , Aleksandra Nadaj-Pakleza 16 , Tanya Stojkovic 17 , Pascal Cintas 18 , Marco Spinazzi 19 , Alexandra Foubert-Samier 9 10 , Shahram Attarian 5



    Objective: To describe the clinical characteristics and outcomes of COVID-19 among patients with MG and identify factors associated with COVID-19 severity in MG patients.
    Methods: The CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS network (between March 1, 2020, and June 8, 2020), including MG patients with a confirmed or highly-suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a polymerase chain reaction (PCR) test from a nasopharyngeal swab and/or SARS-CoV-2 serology, thoracic computed tomography (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 MG patients 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 gender, 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 MG patients during the COVID-19 pandemic.

    Keywords: COVID-19; corticosteroids; immunosuppressant; myasthenia gravis; prognosis; risk factors.