From: The relationship between myasthenia gravis and COVID-19: a systematic review
No. | First author, country | Study design | Subject characteristic | Management | Outcome |
---|---|---|---|---|---|
1 | Adhikari R, USA [38] | Case report | 33 y/o, M, AChR Ab, MG diagnosed before COVID-19 | MV, steroid, symptomatic treatment | Deceased |
2 | Aksoy E, Turkey [39] | Case report | 46 y/o, F, AChR Ab, MG diagnosed before COVID-19 | Pyridostigmine (4 × 60 mg), favipiravir, meropenem, oseltamivir, HCQ (2 × 400 mg x 1d, 2 × 200 mg x 4d), MV, linezolid, MP iv (1 × 40 mg), and plasma therapy | Recovery |
3 | Anand P, USA [46] | Case series | MG diagnosed before COVID-19 1: 57 y/o, M, AChR Ab 2: 64 y/o, M, AChR Ab 3: 90 y/o, F, AChR Ab 4: 42 y/o, F, MuSK Ab 5: 64 y/o, F, AChR Ab | 1: HCQ (2 × 400 mg x 1d, 1 × 200 mg × 2d), AZM (1 × 500 mg x 1d, 1 × 250 mg x 2d), TOZ (300 mg × 1 dose), AZA (1 × 50 mg), MV 2: HCQ (2 × 400 mg x 1d, 1 × 400 mg x 4d), AZM (1 × 500 mg x 1d, 1 × 250 mg x 4d), CTX (1 × 2 g x 2d, 1 × 1 g x 3d), prednisone (1 × 10 mg x 9d, 1 × 5 mg), MV 3: HCQ (2 × 400 mg x 1d, 1 × 400 mg x 4d), AZM (1 × 500 mg x 5d), CTX (1 × 1 g x 5 d), IVIG, prednisone (1 × 25 mg x 6d, 1 × 20 mg) 4: Prednisone (1 × 20 mg), IVIG (2 g/kg/d) 5: AZA, prednisone (1 × 60 mg) | 1: Discharged home on day 9 2: Continued MV 3: Discharged to skilled nursing facility on day 19 4: Discharged home on day 5 5: Discharged home on day 9 |
4 | Assini A, Italy [9] | Case report | 77 y/o, M, MuSK Ab, newly diagnosed ocular MG triggered by COVID-19 | Pyridostigmine (4 × 60 mg), AZA (1.5 mg/kg/d) | Recovery |
5 | Essajee F, South Africa [40] | Case report | 7 y/o, F, AChR Ab, newly diagnosed ocular MG triggered by COVID-19 | IV MP (30 mg/kg/d x 3d) → prednisone 2 mg/kg/d gradually weaned over 4 w, IVIG (2 g/kg/d x 2d), pyridostigmine, methotrexate | Discharge on day 30 |
6 | Huber M, Germany [41] | Case report | 21 y/o, F, AChR Ab, newly diagnosed ocular MG triggered by COVID-19 | IVIG (0.4 g/kg/d x 5d), pyridostigmine (3 × 60 mg, increase to 3 × 120 mg next week) | Recovery |
7 | Karimi N, Iran [47] | Case series | Newly diagnosed ocular MG triggered by COVID-19 1: 61 y/o, F, AChR Ab 2: 57 y/o, M, AChR Ab 3: 38 y/o, F, AChR Ab | 1: PE, pyridostigmine (4 × 60 mg), prednisone (1 mg/kg/d), thymoma surgery 2: pyridostigmine (3 × 60 mg), prednisolone (25 mg/d) 3: pyridostigmine (240 mg), prednisone (25 mg/d) | 1: Recovery 2: Recovery 3: Recovery |
8 | Moschella P, USA [42] | Case report | 70 y/o, M, AChR Ab, MG diagnosed before COVID-19 | MV, hydrocortisone iv (100 mg), PE (5x), pyridostigmine (4 × 60 mg), methotrexate | Recovery |
9 | Octaviana F, Indonesia [13] | Case series | MG diagnosed before COVID-19 1: 25 y/o, F 2: 49 y/o, M 3: 42 y/o, F | 1: Vit C (500 mg/d), NAC (600 mg/d), CTX (2 g/d), pyridostigmine (240 mg/d) → 6 d, AZM (500 mg/d x 1d) 2: AZM (500 mg/d), vit C (3000 mg/d), PCT (1500 mg/d), pyridostigmine (180 mg/d), AZA (100 mg/d)→ 5d 3: HCQ (200 mg/d), NAC (600 mg/d)→ 7 days, MP (16 mg/d), pyridostigmine (240 mg/d), mycophenolate (720 mg/d) | 1: Discharge on day 14 2: Discharge on day 14 3: Discharge on day 14 |
10 | Peters BJ, USA [48] | Case series | MG diagnosed before COVID-19 1: 71 y/o, M 2: 41 y/o, F 3: 59 y/o, M | 1: Remdesivir (200 mg/d x 1d, 100 mg/d x 4d), dexamethasone iv (6 mg/d x 10d), lenzilumab (3 × 600 mg), mycophenolic acid 2: Remdesivir (200 mg/d x 1d, 100 mg/d x 4d), dexamethasone iv (6 mg/d x 10d), mycophenolate (1000 mg in morning, 1500 mg in evening), pyridostigmine (6 × 60 mg), prednisone after dexamethasone (1 × 5 mg) 3: Prone position, remdesivir (200 mg/d x 1d, 100 mg/d x 4d), dexamethasone iv (6 mg x 1d)→ prednisone 60 mg/d, AZA (100 mg in morning, 50 mg in evening), pyridostigmine (3 × 60 mg), MV | 1: Deceased 2: Transferred out of the ICU 3: Discharged to home |
11 | Ramaswamy SB, USA [43] | Case report | 42 y/o, F, AChR Ab, MG diagnosed before COVID-19 | Prednisone (1 × 30 mg), mycophenolate (2 × 1000 mg) | Recovery |
12 | Reddy YM, India [19] | Case report | 65 y/o, M, AChR Ab, newly diagnosed MG triggered by COVID-19 | Remdesivir, IVIG (0,4 mg/kg/d x 5d), prednisolone (30–40 mg/d), AZT (2 × 50 mg), pyridostigmine (4 × 60 mg) | Discharge on day 23 |
13 | Saied Z, Tunisia [14] | Case series | MG diagnosed before COVID-19 1: 40 y/o, F 2: 60 y/o, F 3: 37 y/o, F, AChR Ab 4: 57 y/o, M, AChR Ab 5: 54 y/o, F, AChR Ab | 1: AZM (500 mg/d × 5 d), vit C (1000 mg/day x 10d), vit D (20,000 IU), LMWH x 10d 2: AZM (500 mg/d × 5 d), Vit C (1000 mg/day x 10d), vit D (20,000 IU x 10d), AZA (150 mg/d), pyridostigmine (8 × 60 mg) 3: AZM 500 mg/d × 5 d), vit C (1000 mg/day x 10d), vit D (20,000 IU/d) 4: MV, levofloxacin (500 mg/d), AZA (150 mg/d), pyridostigmine (8 × 60 mg), prednisone (40 mg/d) 5: AZM (500 mg/d × 5 d), Vit C (1000 mg/d × 10 d), Vit D (20,000 IU), LMWH × 10 d, AZA (150 mg), pyridostigmine (8 × 60 mg), IVIG (0.4 g/kg/d × 5 d) | 1: Recovery 2: Recovery 3: Recovery 4: Deceased 5: Recovery |
14 | Singh S, USA [44] | Case report | 36 y/o, F, negative AChR Ab and MuSK Ab, MG diagnosed before COVID-19 | PE (5x), mycophenolate, MV, stress dose steroid iv | Discharged after 1Â month, persistent anosmia |
15 | Sriwastava S, USA [45] | Case report | 65 y/o, F, AChR Ab, newly diagnosed ocular MG triggered by COVID-19 | Pyridostigmine (4 × 60 mg decrease to 3 × 60 mg when admitted to hospital again due to COVID-19 infection), dexamethasone iv (4 doses of 6 mg), azithromycin, 1 unit convalescent plasma | Discharged after 10 days with residual symptoms of COVID-10 and ocular MG |
16 | Zupanic S, Belgian [49] | Case series | MG diagnosed before COVID-19 1: 55 y/o, F, AChR Ab 2: 67 y/o, M, AChR Ab 3: 80 y/o, M 4: 63 y/o, M, AChR Ab 5: 59 y/o, F, negative Ab 6: 58 y/o, M, negative Ab 7: 51 y/o, M, AChR Ab 8: 66 y/o, F | 1: IVIG (0,4 g/kg/d × 5 d), pyridostigmine (240 mg/d), AZA (100 mg), prednisolone (20 mg/d) 2: IVIG (0,4 g/kg/d x 5d), pyridostigmine (300 mg/d), prednisolone (60 mg/d) 3: Pyridostigmine (90 mg/d), remdesivir/5 d, dexamethasone (8 mg × 10 d) 4: IVIG (0,4 g/kg/d x 5d), pyridostigmine (360 mg/d), AZA (100 mg), prednisolone (60 mg/d), MV 5: Pyridostigmine (300 mg/d), dexamethasone (8 mg x 10d) 6: IVIG (0,4 g/kg/d x 5d), pyridostigmine (420 mg/d), prednisolone (30 mg/d), remdesivir/5d, MV 7: IVIG (0,4 g/kg/d x 1d), pyridostigmine (300 mg/d), remdesivir/5d 8: IVIG (0,4 g/kg/d x 5d), prednisolone (20 mg/d), remdesivir/5d, MV | 1: Discharge on day 7 2: Discharge on day 12 3: Discharge on day 10 4: Discharge on day 16 5: Discharge on day 8 6: Discharge on day 15 7: Discharge on day 24 8: Deceased |