Vaccines and Myasthenia Gravis: a Comprehensive Review and Retrospective Study of SARS-CoV-2 Vaccination in a Large Cohort of Myasthenic Patients

Overview

Journal J Neurol

Specialty Neurology

Date 2022 May 3

PMID 35503373

Authors

Giulio Sansone

Domenico Marco Bonifati

Affiliations

Soon will be listed here.

Abstract

Introduction: Myasthenia gravis (MG) is an autoimmune disease, for which the risk of exacerbation after vaccines is debated. The aim of this study is to review the available literature concerning safety and efficacy of vaccines in MG. In addition, we also conducted a retrospective research of MG exacerbations and new onset MG after anti-SARS-CoV-2 vaccination in a large cohort of patients.

Methods: A study of the available literature regarding vaccines and MG was carried out through research in the online database "Pubmed". We also retrospectively collected data from 80 MG patients, who were followed at the Treviso Hospital and completed an anti-SARS-CoV-2 vaccination cycle. For each patient, we recorded MG exacerbations between first and second doses and within a window period of 1 day - 6 weeks after the second dose.

Results: We found 26 relevant articles about influenza, SARS-CoV-2 and other vaccines. No clear associations between most vaccines and MG exacerbations were found. Moreover, cases of new onset post-vaccine MG are mostly anecdotal, except for Japanese encephalitis virus vaccine. Concerning our cohort, 4/80 (5%) MG patients experienced an exacerbation within the post-vaccine window period. In addition, we report a case of new onset post-vaccine MG.

Discussion: Inactivated and subunit vaccines are safe and effective in MG. Although some of them, such as anti-SARS-CoV-2 vaccine, might uncommonly cause MG exacerbations, data from our review suggest that benefits still outweigh by far the potential risks, thus they should be recommended to these patients. Nevertheless, large prospective studies are needed for further investigations.

Citing Articles

Complement inhibition in seropositive generalized myasthenia gravis as rescue therapy in impending and effective treatment in frequently recurring impending myasthenic crisis-a case series.

Menacher M, Ellssel M, Kwiedor I, Naumann M, Bayas A Ther Adv Neurol Disord. 2024; 17:17562864241301361.

PMID: 39735401 PMC: 11672472. DOI: 10.1177/17562864241301361.

The Impact of COVID-19 Vaccination and Infection on the Exacerbation of Myasthenia Gravis.

Jiang Y, Wang J, Su S, Zhang S, Wen Q, Wang Y Vaccines (Basel). 2024; 12(11).

PMID: 39591124 PMC: 11598725. DOI: 10.3390/vaccines12111221.

Predictive Factors for Poor Outcomes Associated with COVID-19 in a Retrospective Cohort of Myasthenia Gravis Patients.

Bi Z, Gao H, Lin J, Gui M, Li Y, Li Z J Inflamm Res. 2024; 17:5807-5820.

PMID: 39224657 PMC: 11368097. DOI: 10.2147/JIR.S475729.

Identifying and reducing risks of neurological complications associated with vaccination.

Handunnetthi L, Ramasamy M, Turtle L, Hunt D Nat Rev Neurol. 2024; 20(9):541-554.

PMID: 39112653 DOI: 10.1038/s41582-024-01000-7.

Recommendations for the management of myasthenia gravis in Belgium.

De Bleecker J, Remiche G, Alonso-Jimenez A, Van Parys V, Bissay V, Delstanche S Acta Neurol Belg. 2024; 124(4):1371-1383.

PMID: 38649556 PMC: 11266451. DOI: 10.1007/s13760-024-02552-7.

References

Gummi R, Kukulka N, Deroche C, Govindarajan R . Factors associated with acute exacerbations of myasthenia gravis. Muscle Nerve. 2019; 60(6):693-699. DOI: 10.1002/mus.26689. View

Magni G, Micaglio G, Ceccato M, LALLI R, Bejato L, Angelini C . The role of life events in the myasthenia gravis outcome: a one-year longitudinal study. Acta Neurol Scand. 1989; 79(4):288-91. DOI: 10.1111/j.1600-0404.1989.tb03786.x. View

Vellozzi C, Iqbal S, Broder K . Guillain-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clin Infect Dis. 2014; 58(8):1149-55. DOI: 10.1093/cid/ciu005. View

Nachamkin I, Shadomy S, Moran A, Cox N, Fitzgerald C, Ung H . Anti-ganglioside antibody induction by swine (A/NJ/1976/H1N1) and other influenza vaccines: insights into vaccine-associated Guillain-Barré syndrome. J Infect Dis. 2008; 198(2):226-33. DOI: 10.1086/589624. View

Martin Arias L, Sanz R, Sainz M, Treceno C, Carvajal A . Guillain-Barré syndrome and influenza vaccines: A meta-analysis. Vaccine. 2015; 33(31):3773-8. DOI: 10.1016/j.vaccine.2015.05.013. View

Mailand M, Frederiksen J . Vaccines and multiple sclerosis: a systematic review. J Neurol. 2016; 264(6):1035-1050. DOI: 10.1007/s00415-016-8263-4. View

McNicholas N, Chataway J . Relapse risk in patients with multiple sclerosis after H1N1 vaccination, with or without seasonal influenza vaccination. J Neurol. 2011; 258(8):1545-7. DOI: 10.1007/s00415-011-5944-x. View

Farez M, Correale J . Yellow fever vaccination and increased relapse rate in travelers with multiple sclerosis. Arch Neurol. 2011; 68(10):1267-71. DOI: 10.1001/archneurol.2011.131. View

Papp K, Haraoui B, Kumar D, Marshall J, Bissonnette R, Bitton A . Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg. 2018; 23(1):50-74. PMC: 6330697. DOI: 10.1177/1203475418811335. View

10.

Koenig H, Sutherland A, Izurieta H, McGonagle D . Application of the immunological disease continuum to study autoimmune and other inflammatory events after vaccination. Vaccine. 2010; 29(5):913-9. DOI: 10.1016/j.vaccine.2010.10.044. View

11.

Sela M, Mozes E . Therapeutic vaccines in autoimmunity. Proc Natl Acad Sci U S A. 2004; 101 Suppl 2:14586-92. PMC: 521984. DOI: 10.1073/pnas.0404826101. View

12.

Berrih-Aknin S, Fuchs S, Souroujon M . Vaccines against myasthenia gravis. Expert Opin Biol Ther. 2005; 5(7):983-95. PMC: 1847363. DOI: 10.1517/14712598.5.7.983. View

13.

Luo J, Lindstrom J . AChR-specific immunosuppressive therapy of myasthenia gravis. Biochem Pharmacol. 2015; 97(4):609-619. DOI: 10.1016/j.bcp.2015.07.011. View

14.

Luo J, Lindstrom J . Antigen-specific immunotherapeutic vaccine for experimental autoimmune myasthenia gravis. J Immunol. 2014; 193(10):5044-55. PMC: 4273672. DOI: 10.4049/jimmunol.1401392. View

15.

Butler M, Tamborska A, Wood G, Ellul M, Thomas R, Galea I . Considerations for causality assessment of neurological and neuropsychiatric complications of SARS-CoV-2 vaccines: from cerebral venous sinus thrombosis to functional neurological disorder. J Neurol Neurosurg Psychiatry. 2021; 92(11):1144-1151. PMC: 7614639. DOI: 10.1136/jnnp-2021-326924. View

16.

Roy B, Litchman T, Torabi T, Nowak R . Influenza vaccination in autoimmune neuromuscular diseases: A survey of current practices and perceptions. Muscle Nerve. 2021; 63(6):918-923. DOI: 10.1002/mus.27224. View

17.

Zinman L, Thoma J, Kwong J, Kopp A, Stukel T, Juurlink D . Safety of influenza vaccination in patients with myasthenia gravis: a population-based study. Muscle Nerve. 2009; 40(6):947-51. DOI: 10.1002/mus.21440. View

18.

Auriel E, Regev K, Dori A, Karni A . Safety of influenza and H1N1 vaccinations in patients with myasthenia gravis, and patient compliance. Muscle Nerve. 2011; 43(6):893-4. DOI: 10.1002/mus.22077. View

19.

Strijbos E, Tannemaat M, Alleman I, de Meel R, Bakker J, van Beek R . A prospective, double-blind, randomized, placebo-controlled study on the efficacy and safety of influenza vaccination in myasthenia gravis. Vaccine. 2019; 37(7):919-925. DOI: 10.1016/j.vaccine.2019.01.007. View

20.

Tackenberg B, Schneider M, Blaes F, Eienbroker C, Schade-Brittinger C, Wellek A . Acetylcholine Receptor Antibody Titers and Clinical Course after Influenza Vaccination in Patients with Myasthenia Gravis: A Double-Blind Randomized Controlled Trial (ProPATIent-Trial). EBioMedicine. 2018; 28:143-150. PMC: 5835557. DOI: 10.1016/j.ebiom.2018.01.007. View