Table 1.
Clinical characteristics, treatments and outcomes of the 15 patients with myasthenia gravis and COVID-19.
| # | Age group* | MGFA pre-adm | Years of MG | Antibody | Baseline immunosuppressive treatment | Thymectomy | Commorbidities | MG symptoms exacerbation | Respiratory support | Chest CT > 50% involvement | cNMB | COVID19 treatments | MG treatments | days of ICU / total hospital stay | MGFA discharge |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ≥60 | I | 15 | AchR+ | Pred 20 qd | No | None | Exacerbation leading to MV | MV | ** | Yes | CTX, AZM, OTV, AMK, TEC | Pred continued | 12/13 | Deceased |
| 2 | ≥60 | I | 3 | AchR+ | Pred 30 qd | No | DM, HTN | Exacerbation leading to MV | MV | Yes | Yes | CTX, AZM, TZP | Pred continued | 8/9 | Deceased |
| 3 | 20–39 | IIA | 13 | AchR+ | Pred 60 qd + AZA 250 qd + IVIg 1g/kg monthly | Yes | None | Exarcerbation without MV | NC | No | No | CTX | Pred and AZA continued, IVIg 2g/kg added | 4/8 | IIA |
| 4 | 40–59 | IIA | 10 | AchR+ | Pred 30 qd + MTX 15 mg weekly | Yes | DM | No | NC | No | No | CTX | Pred increased to 40 mg/day, MTX continued | 16/18 | Remains hospitalized (IIA) |
| 5 | 20–39 | IIA | 4 | N/A | Pred 5 qd + MTX 20 mg weekly | No | HTN, SLE | Exacerbation leading to MV | MV | No | Yes | CTX, OTV, MEM, CST, LZD | Pred continued, MTX withheld | 25/29 | Remains hospitalized (V) |
| 6 | 40–59 | IIA | 14 | N/A | No therapy | Yes | None | Exacerbation leading to MV | MV | Yes | Yes | CLR, CTX, AZM, OTV | None | 7/7 | Deceased |
| 7 | 40–59 | IIA | 9 | AchR+ | Pred 40 qd + CCP 150 mg qd | Yes | HTN, DM, HCV | Exacerbation leading to MV | MV | No | No | CTX, AZM, TZP, MEM | Pred increased, 5 PLEX sessions added, CCP withheld | 25/42 | IIA |
| 8 | 40–59 | IIB | 22 | AchR+ | Pred 10 qd + AZA 200 qd | Yes | GAD | Exacerbation leading to MV | MV | No | No | CTX, AZM, TZP | Pred increased, 4 PLEX sessions added, AZA withheld | 20/24 | IIA |
| 9 | 20–39 | I | 5 | AchR+ | Pred 5 qd + AZA 200 qd | No | DM, Epilepsy | Exacerbation leading to MV | MV | Yes | No | CTX, AZM | Pred continued, 5 PLEX sessions added, AZA withheld | 12/20 | IIA |
| 10 | 20–39 | IIB | 2 | Musk+ | Pred 60 qd + RTX 375mg/m2 | No | None | Exacerbation leading to MV | MV | No | No | CTX, AZM | Pred continued, 5 PLEX sessions added | 16/28 | IIB |
| 11 | 20–39 | I | 11 | AchR+ | Pred 5 qd + AZA 150 qd | No | None | No | NC | No | No | AZM | Pred increased to 20mg/day, AZA continued | 0/3 | I |
| 12 | ≥60 | I | 5 | N/A | Pred 25 qd | No | HTN, asthma | Exacerbation leading to MV | MV | Yes | Yes | CTX, CLR, MEM, VAN | Pred increased | 15/16 | Deceased |
| 13 | 20–39 | IIB | 16 | N/A | Pred 30 qd + AZA 250 qd | Yes | None | Exarcerbation without MV | NC | No | No | CTX, AZM | Pred increased to 60 mg/day and AZA withheld | 0/8 | IIB |
| 14 | ≥60 | III | 1 | AchR+ | Pred 40 qd + IVIg 2g/kg IBW monthly | No | HTN | Exacerbation leading to MV | MV | Yes | No | CTX, AZM, MEM, LZD, AMK, PMB | Pred increased | 32/42 | III |
| 15 | 20–39 | IIA | 4 | AchR+ | Pred 30 qd | No | None | Exacerbation leading to MV | MV | No | Yes | CTX | Pred increased | 17/22 | I |
AMK, Amikacin; AZA, Azathyoprine; AZM, Azithromycin; CCP, Cyclosporin; CLR, Clarithromycin; CST, Colistin; CTX, Ceftriaxone; cNMB, continuous neuromuscular blocking; GAD, generalized anxiety disorder; IVIg, Intravenous immunoglobulin; LZD, Linezolid; MEM, Meropenem; MGFA pre-adm, Myasthenia Gravis Foundation of America score at the month before admission; MTX, Methotrexate; MV, mechanical ventilation; OTV, Oseltamivir; PLEX, Plasma exchange; PMB, Polymyxin B; Pred, Prednisone; RTX, Rituximab; TEC, Teicoplanin; TZP, Piperacillin-tazobactam; VAN, Vancomycin. *Written consent for gender and age information could not be obtained due to pandemic. Age presented in the following groups: 20–39 years, 40–59 years, and 60 years and over. **Not performed due to the critical medical condition.