Outcomes of COVID-19 Infection and Vaccination Among Individuals With Myasthenia Gravis.

Alcantara, Monica; Koh, Maria; Park, Alison L.; Bril, Vera; Barnett, Carolina

Key Points: Question: What are the outcomes of COVID-19 infection and vaccination among individuals with myasthenia gravis compared with the general population and with individuals with another autoimmune disease (rheumatoid arthritis)? Findings: In this cohort study of 4411 people with myasthenia gravis living in Ontario, Canada, adults with myasthenia gravis who contracted COVID-19 had a higher risk of emergency department visit, hospitalization, and death compared with matched general population controls and controls with rheumatoid arthritis. Patients with myasthenia gravis who were vaccinated had less than half the risk of contracting COVID-19; there was negligible risk of severe myasthenia gravis exacerbations after vaccination. Meaning: This population-based study suggests that patients with myasthenia gravis had a high risk of serious COVID-19 infection and worse outcomes compared with the general population, supporting the prioritization of this population for vaccination and early therapeutics for COVID-19. Importance: There are limited data regarding COVID-19 outcomes and vaccine uptake and safety among people with myasthenia gravis (MG). Objective: To investigate COVID-19–related outcomes and vaccine uptake among a population-based sample of adults with MG. Design, Setting, and Participants: This population-based, matched cohort study in Ontario, Canada, used administrative health data from January 15, 2020, and August 31, 2021. Adults with MG were identified using a validated algorithm. Each patient was matched by age, sex, and geographic area of residence to 5 controls from the general population and from a cohort of individuals with rheumatoid arthritis (RA). Exposure: Patients with MG and matched controls. Main Outcomes and Measures: Main outcomes were COVID-19 infection and related hospitalizations, intensive care unit admissions, and 30-day mortality among patients with MG vs controls. Secondary outcomes were uptake of COVID-19 vaccination among patients with MG vs controls. Results: Among 11 365 233 eligible Ontario residents, 4411 patients with MG (mean [SD] age, 67.7 [15.6] years; 2274 women [51.6%]) were matched to 22 055 general population controls (mean [SD] age, 67.7 [15.6] years; 11 370 women [51.6%]) and 22 055 controls with RA (mean [SD] age, 67.7 [15.6] years; 11 370 women [51.6%]). In the matched cohort, 38 861 of 44 110 individuals (88.1%) were urban residents; in the MG cohort, 3901 (88.4%) were urban residents. Between January 15, 2020, and May 17, 2021, 164 patients with MG (3.7%), 669 general population controls (3.0%), and 668 controls with RA (3.0%) contracted COVID-19. Compared with general population controls and controls with RA, patients with MG had higher rates of COVID-19–associated emergency department visits (36.6% [60 of 164] vs 24.4% [163 of 669] vs 29.9% [200 of 668]), hospital admissions (30.5% [50 of 164] vs 15.1% [101 of 669] vs 20.7% [138 of 668]), and 30-day mortality (14.6% [24 of 164] vs 8.5% [57 of 669] vs 9.9% [66 of 668]). By August 2021, 3540 patients with MG (80.3%) vs 17 913 general population controls (81.2%) had received 2 COVID-19 vaccine doses, and 137 (3.1%) vs 628 (2.8%), respectively had received 1 dose. Of 3461 first vaccine doses for patients with MG, fewer than 6 individuals were hospitalized for MG worsening within 30 days of vaccination. Vaccinated patients with MG had a lower risk than unvaccinated patients with MG of contracting COVID-19 (hazard ratio, 0.43; 95% CI, 0.30-0.60). Conclusions and Relevance: This study suggests that adults with MG who contracted COVID-19 had a higher risk of hospitalization and death compared with matched controls. Vaccine uptake was high, with negligible risk of severe MG exacerbations after vaccination, as well as evidence of effectiveness. The findings support public health policies prioritizing people with MG for vaccination and new COVID-19 therapeutics. This cohort study investigates COVID-19–related outcomes and vaccine uptake among a population-based sample of adults with myasthenia gravis.

ONTARIO; MYASTHENIA gravis; COVID-19; CONFIDENCE intervals; COVID-19 vaccines; VACCINATION coverage; CASE-control method; RETROSPECTIVE studies; ACQUISITION of data; VACCINE effectiveness; COMPARATIVE studies; RESEARCH funding; MEDICAL records; DESCRIPTIVE statistics; DATA analysis software; LONGITUDINAL method; DISEASE complications; EVALUATION; ADULTS

JAMA Network Open, 2023, Vol 6, Issue 4, pe239834

2574-3805

Academic Journal

10.1001/jamanetworkopen.2023.9834