Table 2.

COVID-19 therapeutic agents with potential NMD complications.

Therapeutic agents	Potential NMD-relevant side effects	NMD patients with particular caution in use
Hydroxychloroquine	•QTc interval prolongation may lead to cardiac arrest secondary to cardiac arrhythmia, especially when combined with other QTc-prolonging drugs •Newly onset or exacerbation of MG •Risk of toxic neuropathy and myopathy •Cardiotoxicity and cardiomyopathy •Elevated serum CK level	•Autoimmune and congenital MG •NMD with myocardial involvement, i.e. DMD/BMD •Andersen-Tawil syndrome (a rare form of periodic paralysis) •Myotonic dystrophy
Azithromycin	•QTc interval prolongation •Risk of worsening MG	NMD patients who have similar susceptibility to hydroxychloroquine
Lopinavir/Ritonavir	•QTc interval prolongation may lead to cardiac arrest secondary to cardiac arrhythmia, especially when combined with other QTc-prolonging drugs •Risk of toxic myopathy with rhabdomyolysis, especially in combination with a statin	Careful monitoring of serum CK levels when treating in myopathic patients
Remdesivir	•Myalgias in healthy controls •Elevation in liver enzymes	All kinds of susceptible NMD patients should be monitor serum liver enzymes and CK level
Eculizumab	•Myalgias and arthralgias •Elevation in liver enzymes	All kinds of susceptible NMD patients should be monitor serum liver enzymes and CK level

NMD, neuromuscular disorder; CK, creatinine kinase; MG, myasthenia gravis; DMD, Duchenne muscular dystrophy; BMD, Becker muscular dystrophy.