Researchers assessing the safety of vaccines for patients with myasthenia gravis (MG) found that some of them, such as the anti-SARS-CoV-2, may cause MG exacerbations, but evidence points overwhelmingly in favor that they are still recommended for these patients, as published in the Journal of Neurology.

MG, a chronic autoimmune disease affecting the neuromuscular junction, is clinically characterized by the fatigability and fluctuating weakness of skeletal muscles. These symptoms sometimes worsen with physical exercise and resolve with rest. The most severe complications of MG are bulbar exacerbations and myasthenia crises, which can be life-threatening.

There has been some concern about the use of vaccines in patients with immune-mediated diseases. Some speculate that a causal relationship can be deduced between certain vaccines and the onset of disease or exacerbation of existing immune-mediated diseases. There have also been questions raised about the use of vaccines in patients undergoing immunosuppressive therapy.

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The authors of the study hence decided to investigate the safety and efficacy of COVID-19 vaccines in patients with MG. They conducted a literature search via the online database “PubMed.” A total of 29 relevant studies were identified. In addition, they retrospectively collected data from a large cohort of patients with MG in their center who completed 2 doses of the anti-SARS-CoV-2 vaccine.

The researchers discovered case studies detailing how patients with MG reported worsening symptoms after taking the vaccine. In total, they discovered 4 patients who experienced an exacerbation of their MG symptoms. However, preliminary data on the SARS-CoV-2 vaccine show that the overwhelming benefit of the vaccine should prompt physicians to recommend the vaccine even to patients with MG.

“Given the entity of the current pandemics, we believe that the benefits of anti-SARS-CoV-2 vaccination in myasthenic patients still outweigh by far the potential risks,” the authors concluded. “In addition, the reported cases of new onset post-vaccine MG seem to be mostly anecdotal.”

Reference

Sansone G, Bonifati DM. Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patientsJ Neurol. 2022;1-17. doi:10.1007/s00415-022-11140-9