Case Series/Case Reports (Indigo)
During the COVID-19 pandemic, patients with neuromuscular disorders, especially patients with autoimmune myasthenia gravis, might be at greater risk of worse outcomes than otherwise healthy people because of an immunocompromised state related to immunotherapy and possible respiratory and bulbar muscular weakness. However, cessation of immunotherapy in neuroinflammatory disorders has severe risks as well. Moreover, infections are a well-recognised trigger of symptom exacerbation in patients with myasthenia gravis, and some drugs used in therapeutic trials early in the pandemic, including hydroxychloroquine and azithromycin, can provoke symptom exacerbations. The
need for data to answer key clinical questions was quickly recognised and a registry was created to capture high-quality information about outcomes for patients with myasthenia gravis and laboratory-confirmed, or clinically suspected, COVID-19. This physician-reported registry, COVID-19 Associated Risks and Effects in Myasthenia Gravis (CARE-MG), is a joint effort of the International MG/COVID-19 Working Group and neurologists who help to take care of patients with myasthenia gravis globally and was formally launched on April 9, 2020. The registry is still open and active accrual continues through electronic-form or paper form submission of case reports. A total of 91 patients with myasthenia gravis were included at the time of interim analysis (Oct 5, 2020). Myasthenia gravis worsening or crisis requiring rescue therapy (eg, intravenous immunoglobulin, plasma exchange, or steroids) in the setting of COVID-19 was reported in 36 (40%) of 91 patients. Complete recovery or discharge to home was reported in 39 (43%) patients, whereas 22 (24%) patients died due to COVID-19.