Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort.
Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort.
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DOI：
10.3390/neurolint14020033
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发表时间：
2022-04-27
影响因子：
3
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背景和目的。重症肌无力（MG）患者被认为是易感的，因为他们可能出现呼吸肌无力，因为他们正在接受免疫抑制治疗；因此，COVID-19可能对这些患者产生不利影响。针对COVID-19的疫苗目前可用，并且已被证明可以预防易感患者的严重COVID-19。尽管它们有效，但在普通人群中，对疫苗的犹豫尚未完全消除。不幸的是，关于这些疫苗在MG患者中的安全性的数据有限。本研究的目的是评估COVID-19对MG队列的影响，意大利COVID-19疫苗接种的依从性以及MG患者的疫苗安全性。方法。对在意大利巴勒莫大学医院“Paolo Giaccone”神经肌肉诊所就诊的MG患者进行了回顾性队列研究。患者接受了电话访谈，并填写了关于SARS-CoV-2疫苗接种和感染的专门问卷。通过评估疫苗相关不良事件（ae）和比较接种前后MG-ADL评分来评估疫苗安全性。患者恶化定义为MG-ADL评分增加2分或2分以上。结果。在90名参与者中，75人回答了问卷，其中70.5% （n = 53）接种了疫苗；10例未接种疫苗，3例部分接种疫苗。在接种疫苗的患者中，约45% （n = 24）至少发生一次AE，并在一周内完全消退。未观察到严重不良反应和危及生命的情况。在全球范围内，接种疫苗后MG-ADL评分没有恶化。9名未接种疫苗的患者出现了SARS-CoV2感染，其中4名（44%）死亡，1名患者需要呼吸支持，3名患者无症状。结论。COVID-19显著影响MG患者，呼吸道后遗症死亡率增加。针对SARS-CoV-2的疫苗在MG患者中显示出良好的短期安全性，他们可能利用疫苗接种来避免危及生命的并发症，如COVID-19肺炎。
Background and aims. Patients with Myasthenia gravis (MG) are considered vulnerable as they may present with respiratory muscle weakness and because they are on immunosuppressive treatment; thereby, COVID-19 may have a detrimental effect on these patients. Vaccines against COVID-19 are currently available and it has been shown as they can prevent severe COVID-19 in vulnerable patients. Notwithstanding their efficacy, vaccine hesitancy has not been completely dispelled in the general population. Unfortunately, there is limited data about the safety of these vaccines in MG patients. The aims of this study are to evaluate the impact of COVID-19 in a MG cohort, the adherence to COVID-19 vaccination in Italy and vaccine safety in MG patients. Methods. A retrospective cohort study of MG patients attending the Neuromuscular Clinic of the University Hospital “Paolo Giaccone” of Palermo, Italy, was performed. Patients underwent telephone interviews with a dedicated questionnaire on SARS-CoV-2 vaccination and infection. Vaccine safety was assessed though the evaluation of vaccine-related adverse events (AEs) and comparisons of MG-ADL scores before and after vaccination. Patient worsening was defined as two or more point increases in MG-ADL scores. Results. From a total of 90 participants, 75 answered the questionnaire and 70.5% of them (n = 53) received the vaccine; ten patients did not receive vaccination and 3 patients were partially vaccinated. Among the vaccinated patients, about 45% (n = 24) experienced at least one AE, with a complete resolution within one week. No serious AEs and life-threatening conditions were observed. Globally, MG-ADL scores did not worsen after vaccination. Nine unvaccinated patients experienced SARS-CoV2 infection and four of them (44%) died—one patient required respiratory support, whereas three patients were asymptomatic. Conclusions. COVID-19 significantly impacted MG patients with an increase in mortality due to respiratory sequelae. Vaccines against SARS-CoV-2 showed good short-term safety in MG patients, who may take advantage of vaccination to avoiding life-threatening complications such as COVID-19 pneumonia.