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July 2022; 9 (4) Research ArticleOpen Access

Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis

View ORCID ProfileDavid Reyes-Leiva, Joaquín López-Contreras, Esther Moga, Francesc Pla-Juncà, Elionor Lynton-Pons, View ORCID ProfileRicardo Rojas-Garcia, Janina Turon-Sans, View ORCID ProfileLuis Querol, View ORCID ProfileMontse Olive, Rodrigo Álvarez-Velasco, View ORCID ProfileMarta Caballero-Ávila, Álvaro Carbayo, Ana Vesperinas-Castro, Pere Domingo, Isabel Illa, Eduard Gallardo, Elena Cortés-Vicente
First published June 21, 2022, DOI: https://doi.org/10.1212/NXI.0000000000200002
David Reyes-Leiva
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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  • For correspondence: dreyes@santpau.cat
Joaquín López-Contreras
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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  • For correspondence: jlcontreras@santpau.cat
Esther Moga
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Francesc Pla-Juncà
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Elionor Lynton-Pons
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Ricardo Rojas-Garcia
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Janina Turon-Sans
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Luis Querol
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Montse Olive
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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  • For correspondence: molivep@santpau.cat
Rodrigo Álvarez-Velasco
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Marta Caballero-Ávila
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Álvaro Carbayo
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Ana Vesperinas-Castro
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Pere Domingo
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Isabel Illa
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Eduard Gallardo
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Elena Cortés-Vicente
From the Neuromuscular Diseases Unit (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.C.-V.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, “Departament de Medicina,” Universitat Autònoma de Barcelona; Neuromuscular Diseases Lab (D.R.-L., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., A.V.-C., I.I., E.G., E.C.-V.), Institut de Recerca Hospital de la Santa Creu i Sant Pau (IIB-Sant Pau), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) (D.R.-L., F.P.-J., R.R.-G., J.T.-S., L.Q., M.O., R.Á.-V., M.C.-Á., Á.C., I.I., E.G., E.C.-V.), Valencia; Unidad de Enfermedades Infecciosas (J.L.-C., P.D.), Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau; and Department of Immunology (E.M., E.L.-P.), Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain.
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Citation
Immune Response and Safety of SARS-CoV-2 mRNA-1273 Vaccine in Patients With Myasthenia Gravis
David Reyes-Leiva, Joaquín López-Contreras, Esther Moga, Francesc Pla-Juncà, Elionor Lynton-Pons, Ricardo Rojas-Garcia, Janina Turon-Sans, Luis Querol, Montse Olive, Rodrigo Álvarez-Velasco, Marta Caballero-Ávila, Álvaro Carbayo, Ana Vesperinas-Castro, Pere Domingo, Isabel Illa, Eduard Gallardo, Elena Cortés-Vicente
Neurol Neuroimmunol Neuroinflamm Jul 2022, 9 (4) e200002; DOI: 10.1212/NXI.0000000000200002

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    Figure 1 Study Concept

    Patients were prospectively recruited by telephone call over a period of 15 consecutive week days. The baseline MG-ADL score and a blood sample to assess NP-IgG serology and IGRA was obtained before the first dose was administered. Seven days after the first dose, a second MG-ADL score was obtained. The second dose of the vaccine was administered 28 days after the first dose, following the manufacturer's recommendations. A third MG-ADL score was administered a week after the second dose. For all 3 MG-ADL scores, patients were asked about symptoms in the previous 7 days to score each MG-ADL item. A second blood sample was obtained 90 days after the second dose, and IGRA and spike-IgG were determined. During a 6-month-follow-up, COVID-19 symptoms were telematically assessed in all patients. COVID-19 = coronavirus disease 2019; IgG = immunoglobulin G; IGRA = interferon gamma release assay; MG-ADL = myasthenia gravis activities of daily living score; NP-IgG serology = SARS-CoV-2 nucleocapsid protein antibodies serology; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; spike-IgG serology = SARS-CoV-2 spike protein 1 IgG antibodies serology.

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    Figure 2 MG-ADL Score After Vaccination in Accordance With Baseline MG-ADL Score

    Boxplot representing the MG-ADL scores after the first and second doses. The vertical axis represents the MG-ADL score reported by the patients, from minimum to maximum. The horizontal axis represents the MG-ADL score at baseline less than 3 (yellow box) or equal to or greater than 3 (orange box). At both time points, patients with an MG-ADL at baseline of 3 points or more had a higher MG-ADL score after each dose, with higher ranges reflecting greater variability in that group. MG-ADL score = myasthenia gravis activities of daily living score.

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    Figure 3 Antispike-IgG Antibody titers and IGRA Positivity After Vaccinations According to Treatment Group

    (A) Antispike-IgG antibody titers in IU/mL is represented in the dot plot for each treatment group. The mean titer is represented by a black line for each group. Threshold line represents the 5 IU/mL cutoff for positivity. (B) Blue bars indicate the percentage of IGRA-positive patients. The percentage of IGRA-negative patients is indicated in yellow bars. Indeterminate IGRA are represented in green bars. IGRA resulting in borderline tests are represented in purple bars. IgG = immunoglobulin G; IGRA = interferon gamma release assay; IST = immunosuppressant therapy.

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