ABSTRACT
Objective: To investigate the outcome of COVID-19 in myasthenia gravis (MG) patients in 7 neuromuscular centers in the United States between March 2020 and September 2022. Background(s): As COVID-19 has spread worldwide with high capacity for mutation and infectibility, we need to investigate the relationship between COVID-19 and rare disease like MG. An informed decision-making process needs reliable data to prevent and treat complications during COVID-19 in MG patients. Design/Methods: We designed an IRB approved questionnaire to interview 144 MG patients from 7 neuromuscular centers in the United States, using phone calls and online Microsoft Forms. Ninety subject qualified for analysis, where qualification required informed consented subject, positive COVID-19 blood test, and confirmed MG before the onset of COVID. We used the CDC guidelines to categorize the severity of COVID-19, while we used MG quality of life 15r (MG-QOL15r) form to assess MG severity. Result(s): 52% of subjects were older than 65 years. Males constituted 58% of the cohort. Sixty-nine percent had at least one dose of COVID-19 vaccination. During the period of COVID-19, 57% of subjects were taking steroid, 17% took no medication, and the rest took immunotherapeutic, immunoglobulin, or plasmapheresis. Of the 90 subjects, 74% (n = 67) had mild COVID-19 symptoms, 9% (n = 8) moderate, 9% (n = 8) severe and 8% (n = 7) died from COVID-19 complications. During COVID-19 period of infection, 72% (n = 65) had mild MG, 18% (n = 16) moderate, and 10% (n = 9) severe MG symptoms. Conclusion(s): Our study showed that most MG patients had milder COVID-19 disease coarse and were less probable to suffer severe MG symptoms. There was no significant association between the severities of COVID- 19 and MG (P = 0.716) even after controlling for confounding factors. Moreover, we asserted that vaccination (P , 0.001) and younger age (P = 0.006) are associated with better COVID-19 outcome in MG patients.
ABSTRACT
Objective: We evaluated clinical outcomes of myasthenia gravis (MG) patients with COVID-19 infection to determine factors associated with poor outcomes. Background: MG is an autoimmune disease affecting the neuromuscular junction. MG patients often manifest dyspnea and dysphagia and have an increased risk of infection due to immunosuppressants use, which may compound the severity of COVID-19 symptoms. A comprehensive understanding of clinical outcomes of MG-COVID patients is crucial in clinical decision making. Design/Methods: We conducted a retrospective cohort study using the Optum® de-identified COVID-19 Electronic Health Record (EHR) data. Primary outcomes include death, hospitalization, intubation, and ICU stay. We analyzed factors that may affect the outcomes such as age, sex, ethnicity, geographic region, month of COVID-19 diagnosis, comorbidities, and MG-specific treatments. Then, we compared these outcomes with non-MG COVID as well as rheumatoid arthritis (RA), systemic lupus (SLE) and multiple sclerosis (MS) with COVID-19 using a modified multivariable Poisson regression model. Results: Our study includes total of 421,086 individuals with COVID-19 among which 377 were MG-COVID. MG was not associated with increased risk of ventilator use or death but was associated with increased risk of hospitalization (aRR=1.28, 95% CI 1.13-1.46, p <0.001) and ICU stay (aRR=1.51, 95% CI 1.16-1.96, p=0.002) when accounting for the covariates in COVID-19. The mortality of the MG-COVID subgroup was 10%, and it was associated with age 75 or older (aRR=9.57, 95% CI 1.56-58.76, p=0.015) and presence of dysphagia (aRR=1.84, 95% CI 1.06- 3.21, p=0.031) but not immunosuppressants use. The MG-COVID had higher adjusted risks of hospitalization and ICU admission compared to the RA-COVID but similar to the SLE- and MS-COVID subgroups. Conclusions: Our study provides insight into how COVID-19 infection affected MG patients. Neurologists may consider these outcomes when providing MG with COVID-19 patients and their families with treatment options, vaccination counseling, and prognosis.
ABSTRACT
In this era of rapidly changing practice and adoption of tele-neurology in clinical practice due to COVID-19 pandemic, we looked at the physician and patient preference for in-person vs virtual visits to guide clinical decisions about using telemedicine after the crisis is over. Data collected from 520 patient surveys revealed that 50% preferred in-person visits and 26% preferred virtual visits. Sixty-four percent reported physical face-to-face interaction as very important. For receiving a new diagnosis, 55% preferred in-person. Forty percent were worried about not being physically examined. Eightyfour percent believed virtual visits were sufficiently private. Sixty-eight percent did not consider expenses a factor in their decision. While 92% were comfortable with using technology, 55% preferred video communications, and 19% preferred phone calls. The visit preference was not significantly associated with gender, diagnosis, disease severity, and symptom management. Ninety-four neuromuscular specialists across the USA and Canada were phone surveyed in September 2020. 90.43% preferred physical visits when seeing new patients while 45% chose virtual visits for follow-ups. The majority thought that telemedicine reduces revenue (58.51%), quality of service (57.45%), and quality time spent with patients (62.77%). Nevertheless, most surveyed physicians agreed that telemedicine is time-efficient (84.04%), improves patient compliance (70.21%), and will be a long-term solution in clinical practice (67.02%). Fifty-eight percent revealed that telemedicine does not affect workload. The majority of neuromuscular physicians and patients preferred in-person visits for first interaction. Initial visit mandates physical exam that is key for diagnosis, but from patient perspective the significance of face-to-face interaction and non-verbal communication was higher. The importance of telemedicine for follow up visits can improve compliance, and may be beneficial for social and economic reasons. The prospect of improving the quality of care during a virtual interaction is an important factor to consider if we intend to increase satisfaction in the future.