COVID-19 and Vaccination Against Sars-CoV-2 in Patients With Myasthenia Gravis From Belgrade, Serbia

ABSTRACT

Introduction: Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction that causes muscle weakness and fatigability. Majority of MG patients request a long-term immune suppression. Aim: To analyze frequency and severity of COVID- 19 infection in MG patients, as well as frequency of patients vaccinated against SARS-CoV-2. Patients and Methods: 125 MG patients from the central Belgrade municipalities were included - 60.0% females, age at MG onset 50.1 (19.7) years, age at testing 61.7 (16.8) years, AChR positive 78.4% and MuSK positive 8.6%. Results: One third of MG patients have had a COVID- 19 and they were younger compared to those who did not suffer from a COVID-19. Severe COVID- 19 was registered in 27.9% of MG patients, mostly in elder subjects with comorbidities such as cardiac diseases and history of malignancies. Two patients had a lethal outcome. MG worsening was noticed in 21.4% of patients after COVID-19 and 41.8% had COVID-19 sequalae. Majority of our MG patients were vaccinated against SARS-CoV-2 (68.8%). Vaccination was more common among MG patients with diabetes and in those with a milder form of MG. Main reasons not to accept a vaccine were Do not wish to be vaccinated (12 patients), afraid of MG worsening (10), advise of a neurologist (8), and advise of a general practitioner (6). The most common types of vaccine were Sinopharm (42.2%) and Pfizer-BioNTech (25.6%). Adverse events were noticed in 36.0% of vaccinated patients, with mild infection (77.4%) and local reactions (12.9%) being the most common. MG worsening was noticed in 5 (5.8%) vaccinated patients. Conclusion: COVID-19 has placed a significant burden for MG patients, with severe COVID-19 forms and MG worsening being common. Percentage of vaccinated MG patients was higher than in general Serbian population.