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Donadio V, Incensi A, Furia AL, Parisini S, Colaci F, Giannoccaro MP, Morelli L, Ricciardiello F, Di Stasi V, De Maria A, Rizzo G, Liguori R. Small fiber neuropathy associated with COVID-19 infection and vaccination: A prospective case-control study. Eur J Neurol 2025; 32:e16538. [PMID: 39526678 PMCID: PMC11625946 DOI: 10.1111/ene.16538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 09/19/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Small fiber neuropathy (SFN) after both COVID-19 infection or vaccination has been reported in sporadic cases, but a detailed description and comparison are missing. We aimed to screen a large cohort of patients complaining of pain and autonomic symptoms after COVID-19 natural infection or vaccination to ascertain the presence of SFN and its correlation with autoimmune diseases. METHODS We prospectively recruited for this case-control study 66 patients: 33 developing sensory and autonomic symptoms after a natural COVID-19 infection (P-COVID) and 33 after a mRNA vaccination against COVID-19 (P-VAC). We also used 33 matched healthy controls (HC) collected before 2019 when the COVID-19 virus appeared. Patients underwent neurological examination and clinical scales, an extensive serum screening, and skin biopsy to detect small nerve fiber involvement. RESULTS Clinical scales showed higher scores for autonomic symptoms in P-COVID patients than in P-VAC patients, but the other scales did not differ. P-COVID and P-VAC patients showed a significant decrease in somatic small nerve fibers compared with HC, whereas autonomic innervation did not differ. SFN was more frequent in P-COVID patients (94%) than in P-VAC patients (79%). Epidermal innervation was correlated with clinical scales for pain and autonomic dysfunctions. Autoimmune abnormalities were frequent in both groups but importantly they were not correlated with SFN. CONCLUSIONS Somatic SFN was frequently found in both P-COVID and P-VAC patients, with a higher incidence in the former group. Spared skin autonomic innervation was spared in both groups although a subtle autonomic involvement in P-COVID patients was suggested by a high COMPASS-31 scale score. SFN was not correlated with autoimmune dysfunctions, although autoimmune diseases were frequent in both groups.
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Affiliation(s)
- Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - ALessandro Furia
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Sara Parisini
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Francesco Colaci
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Luana Morelli
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Fortuna Ricciardiello
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Vitoantonio Di Stasi
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Andrea De Maria
- Department of Health SciencesUniversity of Genova and IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Infections in Immunocompromised Host Unit, Division of Infectious DiseasesIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
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van Dam KPJ, Wieske L, Stalman EW, Kummer LYL, van der Kooi AJ, Raaphorst J, van de Beek D, Verschuuren JJGM, Ruiter AM, Brusse E, van Doorn PA, Baars AE, van der Pol WL, Goedee HS, ten Brinke A, van Ham SM, Rispens T, Kuijpers TW, Eftimov F. Patient-reported daily functioning after SARS-CoV-2 vaccinations in autoimmune neuromuscular diseases. Eur J Neurol 2024; 31:e16409. [PMID: 39236312 PMCID: PMC11555150 DOI: 10.1111/ene.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/29/2024] [Accepted: 06/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND AND PURPOSE There are concerns for safety regarding SARS-CoV-2 vaccines for patients with autoimmune neuromuscular disease. We compared daily functioning using disease-specific patient-reported outcome measures (PROMs) before and after SARS-CoV-2 vaccinations. METHODS In this substudy of a prospective observational cohort study (Target-to-B!), patients with myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), and idiopathic inflammatory myopathy (IIM) vaccinated against SARS-CoV-2 were included. Surveys of daily functioning (Myasthenia Gravis Activities of Daily Living, Inflammatory Rasch-Built Overall Disability Scale, Multifocal Motor Neuropathy Rasch-Built Overall Disability Scale, and Health Assessment Questionnaire-Disability Index) were sent before first vaccination and every 60 days thereafter for up to 12 months. Regression models were constructed to assess differences in PROM scores related to vaccination, compared to scores unrelated to vaccination. We also assessed the proportion of patients with deterioration of at least the minimal clinically important difference (MCID) between before first vaccination and 60 days thereafter. RESULTS We included 325 patients (median age = 59 years, interquartile range = 47-67, 156 [48%] female sex), of whom 137 (42%) had MG, 79 (24%) had CIDP, 43 (13%) had MMN, and 66 (20%) had IIM. PROM scores related to vaccination did not differ from scores unrelated to vaccination. In paired PROMs, MCID for deterioration was observed in three of 49 (6%) MG patients, of whom none reported a treatment change. In CIDP, MCID for deterioration was observed in eight of 29 patients (28%), of whom two of eight (25%) reported a treatment change. CONCLUSIONS SARS-CoV-2 vaccination had no effect on daily functioning in patients with autoimmune neuromuscular diseases, confirming its safety in these patients.
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Affiliation(s)
- Koos P. J. van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Clinical NeurophysiologySt. Antonius HospitalNieuwegeinthe Netherlands
| | - Eileen W. Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Laura Y. L. Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of ImmunopathologyAmsterdam UMCAmsterdamthe Netherlands
| | - Anneke J. van der Kooi
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Joost Raaphorst
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Diederik van de Beek
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | | | - Annabel M. Ruiter
- Department of NeurologyLeiden University Medical CenterLeidenthe Netherlands
| | - Esther Brusse
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Pieter A. van Doorn
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Adája E. Baars
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and NeurosurgeryBrain Center UMC UtrechtUtrechtthe Netherlands
| | - H. Stephan Goedee
- Department of Neurology and NeurosurgeryBrain Center UMC UtrechtUtrechtthe Netherlands
| | - Anja ten Brinke
- Department of Neurology and NeurosurgeryBrain Center UMC UtrechtUtrechtthe Netherlands
| | - S. Marieke van Ham
- Sanquin Research and Landsteiner Laboratory, Department of ImmunopathologyAmsterdam UMCAmsterdamthe Netherlands
- Swammerdam Institute for Life SciencesUniversity of AmsterdamAmsterdamthe Netherlands
| | - Theo Rispens
- Sanquin Research and Landsteiner Laboratory, Department of ImmunopathologyAmsterdam UMCAmsterdamthe Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology, and Infectious Disease, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, location AMCUniversity of AmsterdamAmsterdamthe Netherlands
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Jiang Y, Wang J, Su S, Zhang S, Wen Q, Wang Y, Li L, Han J, Xie N, Liu H, Sun Y, Lu Y, Di L, Wang M, Xu M, Chen H, Wang S, Wen X, Zhu W, Da Y. The Impact of COVID-19 Vaccination and Infection on the Exacerbation of Myasthenia Gravis. Vaccines (Basel) 2024; 12:1221. [PMID: 39591124 PMCID: PMC11598725 DOI: 10.3390/vaccines12111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/20/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
OBJECTIVES Myasthenia Gravis (MG) is an autoimmune disorder that can exacerbate for various reasons, including vaccination and infection. This study aimed to investigate the safety of COVID-19 vaccines for MG patients, factors influencing MG exacerbation after COVID-19 infection (MECI), the course and prognosis of MECI, and the impact of COVID-19 vaccine on infected MG patients. METHODS Patients were enrolled from the MG database in the Department of Neurology, Xuanwu Hospital, Capital Medical University. Two questionnaires were administered to collect data concerning COVID-19 vaccination (questionnaire 1, Q1) and infection (questionnaire 2, Q2) during two distinct periods. MG exacerbation was defined as an increase of at least two points in the MG activity of daily living (MG-ADL) score. COVID-19 severity was categorized as "hospitalization" or "home management"; Results: During the first data-collecting period, our database registered 1013 adult patients: 273 (26.9%) had received COVID-19 vaccinations and completed Q1, and 8 (2.9%) experienced MG exacerbation after vaccination. During the second data-collecting period, among the newly registered patients, 366 patients completed Q2. Of these, 244 were infected, with 39 (16.0%) experiencing MECI and 21 (8.6%) requiring hospitalization. Multivariate analysis showed that generalized myasthenia gravis was associated with MECI (OR 3.354, 95% CI: 1.423-7.908, p = 0.006). Among the 244 infected patients, 143 had received COVID-19 vaccinations, including 14 who received their booster dose within 6 months before COVID-19 and 129 who were vaccinated more than 6 months before COVID-19. The remaining 101 were unvaccinated. No significant associations were found between COVID-19 vaccination and COVID-19 severity (p = 0.292) or MECI incidence (p = 0.478); Conclusions: COVID-19 vaccines were found to be safe for MG patients in stable condition. Patients with gMG were more susceptible to experiencing MECI. No significant impact of the vaccine on COVID-19 severity or MECI incidence was observed.
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Affiliation(s)
- Yuting Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Jingsi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shengyao Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Shu Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Qi Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yaye Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Ling Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Tianjin 4th Centre Hospital, Tianjin 300140, China
| | - Jianxin Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing 102401, China
| | - Nairong Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Haoran Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yanan Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
- Department of Neurology, Dalian Municipal Friendship Hospital, Dalian 116001, China
| | - Yan Lu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Li Di
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Min Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Suobin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Xinmei Wen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Wenjia Zhu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
| | - Yuwei Da
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (Y.J.); (J.W.); (S.S.); (S.Z.); (Q.W.); (Y.W.); (L.L.); (J.H.); (N.X.); (H.L.); (Y.S.); (Y.L.); (L.D.); (M.W.); (M.X.); (H.C.); (S.W.); (X.W.); (W.Z.)
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Li J, Zheng Y, Zhao Y, Qi K, Lin G, Liu R, Hao H, Wang Z, Yuan Y, Gao F. COVID-19 in patients with myasthenia gravis: a single-center retrospective study in China. Neurol Sci 2024; 45:2969-2976. [PMID: 38652194 DOI: 10.1007/s10072-024-07518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been a great concern since 2019. Patients with myasthenia gravis (MG) may be at higher risk of COVID-19 and a more severe disease course. We examined the associations between COVID-19 and MG. METHODS This single-center retrospective cohort study involved 134 patients who were diagnosed with MG from June 2020 to November 2022 and followed up until April 2023. They were divided into a COVID-19 group and non-COVID-19 group. Logistic regression analysis was used to detect factors potentially associating COVID-19 with MG. RESULTS Of the 134 patients with MG, 108 (80.6%) had COVID-19. A higher number of comorbidities was significantly associated with an increased risk of COVID-19 (p = 0.040). A total of 103 patients (95.4%) had mild/moderate COVID-19 symptoms, and 4 patients (3.7%) were severe/critical symptoms (including 2 deaths). Higher age (p = 0.036), use of rituximab (p = 0.037), tumors other than thymoma (p = 0.031), Hashimoto's thyroiditis (p = 0.011), more comorbidities (p = 0.002), and a higher baseline MG activities of daily living (MG-ADL) score (p = 0.006) were risk factors for severe COVID-19 symptoms. The MG-ADL score increased by ≥ 2 points in 16 (15.7%) patients. Dry cough and/or expectoration (p = 0.011), use of oral corticosteroids (p = 0.033), and use of more than one kind of immunosuppressant (p = 0.017) were associated with the increase of the post-COVID-19 MG-ADL score. CONCLUSION Most patients with MG have a mild course of COVID-19. However, patients with older age, many comorbidities, a high MG-ADL score, and use of a variety of immunosuppressants during COVID-19 may be more prone to severe symptoms.
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Affiliation(s)
- Jiayi Li
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yiming Zheng
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yawen Zhao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Kang Qi
- Department of Thoracic Surgery, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Gang Lin
- Department of Thoracic Surgery, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ran Liu
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hongjun Hao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhaoxia Wang
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yun Yuan
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Feng Gao
- Neurology Department, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Zheng W, Cao X, Luo J, Liu Z, Que W, Guo X, Fan R, Long Q, Xiao F. Safety and neutralization antibody levels of inactivated SARS-CoV-2 vaccine in adult patients with Myasthenia Gravis: a prospective observational cohort study. Neurol Sci 2024; 45:1707-1717. [PMID: 37940750 DOI: 10.1007/s10072-023-07186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction. No cohort study has investigated the efficacy of inactivated vaccines in patients with MG. MATERIALS AND METHODS This prospective observational cohort study included healthy controls (HCs) and patients with MG with or without immunosuppressive treatment. Vaccination occurred between May and December 2021. Patients with MG were subjected to a clinical scale assessment for disease severity. The neutralization antibodies (Nabs) levels were measured in all participants using the pseudovirus neutralization assay. RESULTS Twenty-one patients (Female/Male:10/11); age median [interquartile range (IQR)]: 43 [30, 56]) were included in this study. Two patients (2/21) were lost during follow-up after enrollment. No sustained vaccine-related adverse effects occurred in any visit of patients with MG. No exacerbation of MG was observed. Acetylcholine receptor antibody (AChR-Ab) levels showed no statistically significant changes between the first and second visit (median [IQR]: 2.22 [0.99, 2.63] nmol/L vs. 1.54 [1.07, 2.40] nmol/L, p = 0.424). However, levels of AChR-Ab decreased at the third visit (median [IQR]: 2.22 [0.96, 2.70] nmol/L vs. 1.69 [0.70, 1.85] nmol/L, p = 0.011). No statistically significant difference in Nabs levels was found between HCs and patients with MG (median [IQR]: 102.89 [33.13, 293.86] vs. 79.29 [37.50, 141.93], p = 0.147). DISCUSSION The safety of the SARS-CoV-2 inactivated vaccine was reconfirmed in this study. No significant difference in Nabs level was found between patients with MG and HCs. Nabs levels correlated with AChR-Ab levels before vaccination and ΔAChR-Ab levels.
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Affiliation(s)
- Wei Zheng
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xiaoxia Cao
- Key Laboratory of Molecular Biology On Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Jing Luo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Zhuoting Liu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Wenjun Que
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
- Department of Blood Transfusion, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Guo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
- Department of Neurology, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Rui Fan
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Quanxin Long
- Key Laboratory of Molecular Biology On Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
| | - Fei Xiao
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China.
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Ning F, Cao XQ, Wang QQ, Li ZY, Ruan Z, Chang T. Safety of SARS-CoV-2 vaccine in patients with autoimmune neurological conditions: A systematic review and meta-analysis. Heliyon 2024; 10:e23944. [PMID: 38261862 PMCID: PMC10796982 DOI: 10.1016/j.heliyon.2023.e23944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/06/2023] [Accepted: 12/16/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Risk of adverse effects and exacerbation in autoimmune neurological conditions (ANC)are frequently cited reasons for COVID-19 vaccine hesitancy. This study evaluates the ANC safety of COVID-19 vaccines in the real world. Methods Electronic databases were searched to identify studies reporting the use of the COVID-19 vaccine in ANC. We selected studies that provided data on adverse effects and worsening conditions related to ANC after vaccination. The pooled incidence rates for various adverse effects, stratified for the disease category, dosage, and type of vaccine, were estimated. Results Twenty-eight studies (31 vaccination cohorts) were included. The pooled incidence rate of general adverse events was 0.35 (95%CI, 0.27-0.43, I2 = 100 %). The pooled incidence rates of local injection reaction, fatigue, weakness, myalgia, fever, headache, and chills were 0.27 (0.18-0.36, I2 = 98 %), 0.16(0.11-0.21, I2 = 93 %), 0.15(0.00-0.31, I2 = 97 %), 0.13(0.08-0.19, I2 = 97 %), 0.11(0.07-0.15, I2 = 95 %), 0.11(0.07-0.16, I2 = 97 %), and 0.09 (0.03-0.16, I2 = 96 %), respectively. The pooled incidence rate of exacerbation adverse events was 0.05 (95%CI, 0.04-0.07, I2 = 84 %). Conclusion According to available evidence, the administration of COVID-19 vaccines in individuals with autoimmune neurological disorders seems well-tolerated, with few reports of adverse events. Furthermore, exacerbation of autoimmune neurological conditions following vaccination appears to be infrequent.
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Affiliation(s)
| | | | - Qing-qing Wang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhu-yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
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Zheng Q, Cheng Y, Song C, Feng Z, Xu Z. Safety of SARS-CoV-2 vaccines in patients with myasthenia gravis: a meta-analysis. Neurol Sci 2023; 44:2999-3003. [PMID: 37243794 PMCID: PMC10224648 DOI: 10.1007/s10072-023-06875-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Qian Zheng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Chengxin Song
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Zucai Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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Peng S, Tian Y, Meng L, Fang R, Chang W, Yang Y, Li S, Shen Q, Ni J, Zhu W. The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review. Front Immunol 2022; 13:1103020. [PMID: 36618419 PMCID: PMC9812949 DOI: 10.3389/fimmu.2022.1103020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background COVID-19 vaccines are required for individuals with myasthenia gravis (MG), as these patients are more likely to experience severe pneumonia, myasthenia crises, and higher mortality rate. However, direct data on the safety of COVID-19 vaccines in patients with MG are lacking, which results in hesitation in vaccination. This scoping was conducted to collect and summarize the existing evidence on this issue. Methods PubMed, Cochrane Library, and Web of Science were searched for studies using inclusion and exclusion criteria. Article titles, authors, study designs, demographics of patients, vaccination information, adverse events (AEs), significant findings, and conclusions of included studies were recorded and summarized. Results Twenty-nine studies conducted in 16 different countries in 2021 and 2022 were included. Study designs included case report, case series, cohort study, cross-sectional study, survey-based study, chart review, and systemic review. A total of 1347 patients were included. The vaccines used included BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, inactivated vaccines, and recombinant subunit vaccines. Fifteen case studies included 48 patients reported that 23 experienced new-onset, and five patients experienced flare of symptoms. Eleven other types of studies included 1299 patients reported that nine patients experienced new-onset, and 60 participants experienced flare of symptoms. Common AEs included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia. Most patients responded well to treatment without severe sequelae. Evidence gaps include limited strength of study designs, type and dose of vaccines varied, inconsistent window of risk and exacerbation criteria, limited number of participants, and lack of efficacy evaluation. Conclusion COVID-19 vaccines may cause new-onset or worsening of MG in a small proportion of population. Large-scale, multicenter, prospective, and rigorous studies are required to verify their safety.
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Affiliation(s)
- Siyang Peng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yukun Tian
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linghao Meng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruiying Fang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiqian Chang
- Department of Acupuncture, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine Ji’nan Hospital (Ji’nan Hospital of Traditional Chinese Medicine), Shandong, China
| | - Yajing Yang
- Department of Traditional Chinese Medicine, Yuyuantan Community Health Center, Beijing, China
| | - Shaohong Li
- Treatment Center of Traditional Chinese Medicine, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China,Treatment Center of Traditional Chinese Medicine, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Qiqi Shen
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinxia Ni
- Department of Acupuncture, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenzeng Zhu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China,*Correspondence: Wenzeng Zhu,
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