COVID-19 Infection Can Prolong Hospital Stays for MG Patients in US

COVID-19 infection prolongs the length of hospital stay by nearly twofold for patients with myasthenia gravis (MG), according to a U.S. database study.

The study, “Impact of COVID-19 infection among myasthenia gravis patients- a Cerner Real-World Data study,” was published in the journal BMC Neurology.

In MG, the body’s immune system mistakenly attacks acetylcholine receptors (AChR) and other proteins that play a key role in nerve-muscle communication and muscle contraction. Depending on which muscles are affected, MG symptoms may vary. Common symptoms include visual problems, muscle weakness, and tiredness.

MG patients may also have exacerbations, or a sudden episodes of symptom worsening. Some experience life-threatening MG crises in which muscles involved in breathing become weak. About 15%–20% of people with MG experience a crisis that requires intubation and hospitalization once in their lifetime.

To help manage disease-related symptoms, medications known as immunosuppressants that work by inhibiting the body’s immune response are sometimes prescribed. However, these therapies put people with MG at a higher risk of infections, including COVID-19.

Now, a team of researchers at the University of Missouri sought to understand how COVID-19 affects people with MG.

Using anonymized real-world clinical data from the Cerner Real-World Data database, which was provided through Cerner’s HealtheDataLab research tool, the researchers searched and identified MG patients who had COVID-19 and those who didn’t, from January 2019 to July 2020.

The COVID-19 dataset included data of 117,000 patients from 62 contributing health centers and included all patients who tested for COVID-19 at some point during their visits. A total of 91 patients had MG, 27 of whom tested positive for COVID-19.

Researchers then examined factors such as ethnicity, gender, age, prescribed medications, the presence of other diseases (also known as comorbidities), and the length of stay after the COVID-19 test result.

The mean age of MG patients who tested positive for COVID-19 was similar to that of patients who tested negative (64.33 vs. 63.23 years). Both groups had about the same number of men and women.

From the database, the team also extracted the start and end date of medications that were prescribed after the COVID-19 test result. On the list of treatments were corticosteroids, such as prednisone and methylprednisolone, pyridostigmine (sold as Mestinon, among other brand names), CellCept (mycophenolate mofetil), and immunoglobulin therapy.

Among infected patients, 13 developed pneumonia, nine septic shock, and 10 acute respiratory failure.

“In our study, four patients with COVID-19 infection developed exacerbation, and the precipitating factor is likely to be the COVID-19 infection,” the researchers wrote.

The team noted that people with COVID-19 infection and other conditions, such as high blood pressure, diabetes mellitus, heart disease, and respiratory diseases, may be at a higher risk of developing complications than those without any comorbidity. However, in their study, no association was found between comorbidities and COVID-19 infection in MG patients.

Thirteen patients with MG were hospitalized, including seven COVID-19-positive and six negative. The mean length of hospital stay for MG patients in the COVID-19-positive group was 8.28 days, while those in the negative group stayed for a mean of 4.33 days.

“Our study utilized the de-identified real-world data from the CERNER database, and the data was analyzed to report the characteristics of the patients and the outcomes,” the researchers wrote.

“The mean length of hospital stay is prolonged in myasthenia patients who tested positive for COVID-19,” they concluded.