1Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Dubrava University Hospital, Zagreb, Croatia; 3Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia.
Acta Clin Croat. 2022 Feb;60(3):496-509. doi: 10.20471/acc.2021.60.03.21.
Coronavirus disease 2019 (COVID-19), caused by the late 2019 outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a respiratory disease which could put myasthenia gravis (MG) patients at a greater risk of developing severe disease course, since infections and some drugs are a well-recognized trigger of symptom exacerbation in MG patients. Out of ten most commonly used past and present drugs used in COVID-19 treatment, two (quinolone derivatives and azithromycin) are known to worsen MG symptoms, whereas another two (tocilizumab and eculizumab) might have positive effect on MG symptoms. Colchicine, remdesivir, lopinavir, ritonavir and favipiravir seem to be safe to use, while data are insufficient for bamlanivimab, although it is also probably safe to use. Considering MG treatment options in patients infected with SARS-CoV-2, acetylcholine esterase inhibitors are generally safe to use with some preliminary studies even demonstrating therapeutic properties in regard to COVID-19. Corticosteroids are in general safe to use, even recommended in specific circumstances, whereas other immunosuppressive medications (mycophenolate mofetil, azathioprine, cyclosporine, methotrexate) are probably safe to use. The only exception is rituximab since the resulting B cell depletion can lead to more severe COVID-19 disease. Concerning plasmapheresis and intravenous immunoglobulins, both can be used in COVID-19 while taking into consideration thromboembolic properties of the former and hemodynamic disturbances of the latter. As current data suggest, all known COVID-19 vaccines are safe to use in MG patients.
新型冠状病毒病（COVID-19）由 2019 年底爆发的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起，是一种呼吸道疾病，可能使重症肌无力（MG）患者面临更大的罹患重症疾病的风险，因为感染和某些药物是 MG 患者症状恶化的公认诱因。在 COVID-19 治疗中最常使用的十种过去和现在的药物中，有两种（喹诺酮衍生物和阿奇霉素）已知会加重 MG 症状，而另外两种（托珠单抗和依库珠单抗）可能对 MG 症状有积极影响。秋水仙碱、瑞德西韦、洛匹那韦、利托那韦和法匹拉韦似乎可以安全使用，而巴姆单抗的数据不足，但也可能安全使用。考虑到感染 SARS-CoV-2 的 MG 患者的治疗选择，乙酰胆碱酯酶抑制剂通常可以安全使用，一些初步研究甚至表明其具有针对 COVID-19 的治疗特性。皮质类固醇通常可以安全使用，甚至在特定情况下推荐使用，而其他免疫抑制药物（霉酚酸酯、硫唑嘌呤、环孢素、甲氨蝶呤）可能安全使用。唯一的例外是利妥昔单抗，因为其导致的 B 细胞耗竭可能导致更严重的 COVID-19 疾病。关于血浆置换和静脉注射免疫球蛋白，两者都可以在 COVID-19 期间使用，同时考虑到前者的血栓栓塞特性和后者的血流动力学紊乱。根据目前的数据，所有已知的 COVID-19 疫苗在 MG 患者中都是安全的。
