Review article

https://doi.org/10.20471/acc.2021.60.03.21

Treatment of Myasthenia Gravis Patients with COVID-19: Review of the Literature

Sven Županić ; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Dubrava University Hospital, Zagreb, Croatia
Ines Lazibat ; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Dubrava University Hospital, Zagreb, Croatia
Maja Rubinić Majdak ; Dubrava University Hospital, Zagreb, Croatia
Mia Jeličić ; Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia

Abstract

Coronavirus disease 2019 (COVID-19), caused by the late 2019 outbreak of severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a respiratory disease which
could put myasthenia gravis (MG) patients at a greater risk of developing severe disease course, since
infections and some drugs are a well-recognized trigger of symptom exacerbation in MG patients.
Out of ten most commonly used past and present drugs used in COVID-19 treatment, two (quinolone
derivatives and azithromycin) are known to worsen MG symptoms, whereas another two (tocilizumab
and eculizumab) might have positive effect on MG symptoms. Colchicine, remdesivir, lopinavir,
ritonavir and favipiravir seem to be safe to use, while data are insufficient for bamlanivimab, although
it is also probably safe to use. Considering MG treatment options in patients infected with
SARS-CoV-2, acetylcholine esterase inhibitors are generally safe to use with some preliminary studies
even demonstrating therapeutic properties in regard to COVID-19. Corticosteroids are in general
safe to use, even recommended in specific circumstances, whereas other immunosuppressive medications
(mycophenolate mofetil, azathioprine, cyclosporine, methotrexate) are probably safe to use. The
only exception is rituximab since the resulting B cell depletion can lead to more severe COVID-19
disease. Concerning plasmapheresis and intravenous immunoglobulins, both can be used in COVID-
19 while taking into consideration thromboembolic properties of the former and hemodynamic
disturbances of the latter. As current data suggest, all known COVID-19 vaccines are safe to use in
MG patients.

Keywords

Myasthenia gravis; COVID-19; Immunosuppression; COVID-19 vaccine; Neuromuscular disorders

Hrčak ID:

271672

URI

https://hrcak.srce.hr/271672

Publication date:

1.9.2021.

Article data in other languages: croatian

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