A study recently published in Respiratory Medicine found that long COVID — a condition where some symptoms of COVID remain long after a patient has recovered from the initial infection — can cause exacerbation in people living with myasthenia gravis (MG).
Researchers tracked 180 adults with confirmed MG who contracted COVID-19, performing ongoing assessments over 12 months to observe both MG disease burden and symptoms of long COVID. Long COVID was defined as symptoms lasting four weeks or longer after the initial infection.
During follow-up, 62 participants experienced new or worsening MG symptoms, with nearly half classified as severe based on Myasthenia Gravis Activities of Daily Living (MG-ADL) scores. Most exacerbations happened early, with 83.9% reported within the first month after infection and 93.5% documented by six months.
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The authors identified three independent predictors of exacerbation: long COVID, acetylcholinesterase inhibitor use and more severe acute COVID-19 classification.
Long COVID showed the strongest association: Those with long COVID had a two-and-a-half times higher risk of suffering an exacerbation compared to participants who cleared the COVID infection without residual symptoms. MG-ADL scores consistently remained higher in the long COVID group across all assessments.
“Long COVID emerged as the strongest predictor of exacerbation across all models, even after adjusting for age and sex,” the authors wrote, noting that multiple analytic strategies produced similar results.
The investigators also tested simple predictive tools using the same dataset, but these exploratory models supported the same conclusion: Prolonged post-COVID symptoms were closely linked to subsequent MG worsening.
Sensitivity analyses showed that the association between long COVID and exacerbation did not differ by age, sex, body mass index or ethnicity. Six participants died during the study period, all following severe MG exacerbation.
These findings suggest that MG patients who continue to experience post-COVID symptoms may face a higher risk of disease worsening during recovery.
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