tetano
Editor, Senior Moderator
Neurology
. 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?[SUP] 1 [/SUP], St?phane Mathis[SUP] 2 3 [/SUP], Diane Friedman[SUP] 4 [/SUP], Emmanuelle Salort-Campana[SUP] 5 [/SUP], C?line Tard[SUP] 6 [/SUP], Fran?oise Bouhour[SUP] 7 [/SUP], Armelle Magot[SUP] 8 [/SUP], Djillali Annane[SUP] 4 [/SUP], Bernard Clair[SUP] 4 [/SUP], Gwendal Le Masson[SUP] 2 3 [/SUP], Antoine Soulages[SUP] 2 3 [/SUP], Fanny Duval[SUP] 2 [/SUP], Louis Carla[SUP] 2 3 [/SUP], Marie-H?l?ne Violleau[SUP] 2 [/SUP], Tiphaine Saulnier[SUP] 9 10 [/SUP], Sandrine Segovia-Kueny[SUP] 11 [/SUP], L?a Kern[SUP] 12 [/SUP], Jean-Christophe Antoine[SUP] 13 [/SUP], Guillemette Beaudonnet[SUP] 14 [/SUP], Fr?d?rique Audic[SUP] 15 [/SUP], Laurent Kremer[SUP] 16 [/SUP], Jean-Baptiste Chanson[SUP] 16 [/SUP], Aleksandra Nadaj-Pakleza[SUP] 16 [/SUP], Tanya Stojkovic[SUP] 17 [/SUP], Pascal Cintas[SUP] 18 [/SUP], Marco Spinazzi[SUP] 19 [/SUP], Alexandra Foubert-Samier[SUP] 9 10 [/SUP], Shahram Attarian[SUP] 5 [/SUP]
Affiliations
Abstract
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.
. 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?[SUP] 1 [/SUP], St?phane Mathis[SUP] 2 3 [/SUP], Diane Friedman[SUP] 4 [/SUP], Emmanuelle Salort-Campana[SUP] 5 [/SUP], C?line Tard[SUP] 6 [/SUP], Fran?oise Bouhour[SUP] 7 [/SUP], Armelle Magot[SUP] 8 [/SUP], Djillali Annane[SUP] 4 [/SUP], Bernard Clair[SUP] 4 [/SUP], Gwendal Le Masson[SUP] 2 3 [/SUP], Antoine Soulages[SUP] 2 3 [/SUP], Fanny Duval[SUP] 2 [/SUP], Louis Carla[SUP] 2 3 [/SUP], Marie-H?l?ne Violleau[SUP] 2 [/SUP], Tiphaine Saulnier[SUP] 9 10 [/SUP], Sandrine Segovia-Kueny[SUP] 11 [/SUP], L?a Kern[SUP] 12 [/SUP], Jean-Christophe Antoine[SUP] 13 [/SUP], Guillemette Beaudonnet[SUP] 14 [/SUP], Fr?d?rique Audic[SUP] 15 [/SUP], Laurent Kremer[SUP] 16 [/SUP], Jean-Baptiste Chanson[SUP] 16 [/SUP], Aleksandra Nadaj-Pakleza[SUP] 16 [/SUP], Tanya Stojkovic[SUP] 17 [/SUP], Pascal Cintas[SUP] 18 [/SUP], Marco Spinazzi[SUP] 19 [/SUP], Alexandra Foubert-Samier[SUP] 9 10 [/SUP], Shahram Attarian[SUP] 5 [/SUP]
Affiliations
- PMID: 33568541
- DOI: 10.1212/WNL.0000000000011669
Abstract
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.