COVID-19 vaccination appears to be safe in patients with myasthenia gravis (MG) and is associated with reduced COVID-19 infection rates, hospitalization rates and MG flare-up rates, according to a recently published study in Muscle and Nerve.
Patients with MG often receive immunosuppressive therapies, which can lead to worse outcomes following infection and reduced responses to vaccination. Consequently, many patients were — and remain — uncertain about COVID-19 vaccine safety and effectiveness.
Early in the pandemic, limited MG-specific data and concerns about blunted immune responses with agents such as mycophenolate or rituximab amplified hesitancy. To address this knowledge gap, the authors aimed to document real-world vaccination uptake, side effects and COVID-19 outcomes in myasthenia gravis.
Specifically, the study focused on determining the proportion of vaccinated patients with MG, evaluating vaccine safety in this population, identifying reasons for remaining unvaccinated and comparing infection and hospitalization rates after vaccination.
Researchers conducted a REDCap-based, voluntary Myasthenia Gravis Foundation of America (MGFA) outreach survey from Sept. 21 to Nov. 18, 2021, with follow-up between January and March 2022. The baseline questionnaire assessed demographics, MG status, treatments, COVID-19 infections and vaccination experiences.
Of more than 1,200 respondents, 91% reported receiving at least one COVID-19 vaccine dose, most of whom were on immunosuppressive treatment at the time. mRNA vaccines were the most frequently administered. More than half reported receiving a third dose during the first survey window.
Among the 8.5% who were unvaccinated, the leading reasons were concerns about vaccine-related MG worsening, side effects or reduced efficacy due to MG medications.
“Reported side effects in MG patients were comparable to those in the general population,” the study’s authors noted. Side effects were common but generally mild: 61.7% reported adverse effects, most often fatigue, injection-site reactions, muscle pain and headache. About 19.7% of patients reported vaccine-associated MG symptom worsening, and 7.3% required medication adjustments.
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COVID-19 infection rates fell from 9.7% pre-vaccination to 2.4% among vaccinated participants at baseline and 1.8% at follow-up. Hospitalizations dropped from 2.3% pre-vaccination to 0.3% post-vaccination at baseline and 0% at follow-up.
Myasthenia gravis exacerbations during COVID-19 decreased from 5.5% in unvaccinated participants to 1.4% in vaccinated participants at baseline and 0.5% at follow-up. ICU admissions and hospital days were also significantly lower post-vaccination.
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