MG Patients Should Be Priority for COVID-19 Vaccine, Report Says, Citing Risks

People with myasthenia gravis (MG) are at greater risk of being hospitalized or dying from COVID-19 than the general public, and should be prioritized for vaccination, researchers report.

COVID-19 vaccines are likely to be safe for MG patients, they added, given that “multiple studies suggest that the influenza vaccine is safe” for them. Safety findings specific to COVID-19 vaccination are not yet available.

A letter to the editor describing these data, “Electronic health record derived-impact of COVID-19 on myasthenia gravis,” was published in the Journal of the Neurological Sciences.

Data indicate that patients on immunosuppressants to treat chronic autoimmune neuromuscular conditions, such as MG, are more likely to hospitalized due to COVID-19.

Preliminary findings among 91 infected MG patients in a registry — the COVID-19 Associated Risks and Effects in Myasthenia Gravis (CARE-MG) registry  — found a mortality rate of 24%, and a disease relapse rate was 40%.

To further assess the COVID-19 risk and outcomes in MG, researchers at Yale University School of Medicine and University of Arkansas for Medical Sciences analyzed patient data in the TriNetX COVID-19 research network, a global health research database that collects real-time medical records.

As of Dec. 22, 2020, the database listed 40,392 MG patients, with 380 having COVID-19. The majority of these infected patients were male (51.3%), Caucasian (63%), and not of Hispanic or of Latino ethnicity (64%). Their mean age was 63.2.

Among this group, 102 were hospitalized (26.8%), 38 required intensive care (10%), 20 needed to be intubated or experienced disease exacerbation (5.3% each), and 26 had died (6.8%).

People with MG and COVID-19 were three times more likely to be hospitalized and 4.3 times more likely to die than were other patients with COVID-19 in the database. Those with MG were also 5.2 times more likely to require intensive care and 4.6 times more likely to need intubation than other patients.

To make the groups more similar, the research team next matched MG and non-MG patients by age and sex. Although the differences were lower, the risk of hospitalization (1.7 times higher), death (twice as likely), and need for intensive care or intubation (2.9 times and 1.7 times more likely) were again significantly higher in MG patients than in those with COVID-19 but not MG.

“Our study demonstrates that while the rate of SARS-CoV-2 infection [which causes COVID-19] was comparable to the general population, the risk of hospitalization and death was greater,” the investigators wrote.

Researchers noted that while factors such as hospitalization, disease exacerbation, and death rates were lower than previously reported in the CARE-MG registry, these data further support the higher risk of worse outcomes with COVID-19 infection in MG patients.

Differences may be due to more severe cases being part of the physician-reported CARE-MG, although data collected via this method may be more accurate than the electronic health records of TriNetX, the scientists said.

Still, “these results add to the small knowledge base of the impact of COVID-19 in MG patients and can aid in public health decision-making practices and recommendations,” they wrote.

“Considering present data available, patients with MG should be prioritized for SARS-CoV-2 vaccination with additional consideration of best practice standards,” the researchers added.

While the safety of COVID-19 vaccination cannot yet be assured, these vaccines and the widely studied influenza vaccine “both work by triggering immune response regardless of preparation differences, and would be expected to have similar safety in MG patients as in the general population,” they wrote.