In this episode, I’ll discuss whether remdesivir can be used in patients with COVID-19 and Myasthenia Gravis (MG).
Myasthenia Gravis is a neuromuscular junction disease that results from the production of autoantibodies directed against the nicotinic acetylcholine receptor.
The Myasthenia Gravis Foundation of America keeps a list of medications that may potentially exacerbate myasthenia symptoms on their website, myasthenia.org.
The Myasthenia Gravis Foundation of America recommends that any time a new medication is given to a patient with Myasthenia Gravis, it is prudent to assume it might exacerbate the condition and to monitor accordingly. They state:
The best recommendation is to be alert to those drugs which have been reported in the literature to be associated with a development of or worsening of myasthenia gravis, and to be cautious in using such drugs in known myasthenics. One can safely say that many drugs can have an effect on neuromuscular transmission and, in occasional patients, appear to adversely affect their clinical status – particularly if they have a known underlying defect of neuromuscular transmission. It behooves the neurologist to consider the potential for increasing weakness in any patient receiving a new medication, even if it is not on a list of drugs reported to aggravate myasthenia gravis.
Remdesivir previously did not have published data on use in patients with myasthenia gravis, but authors recently published in the journal Pharmacotherapy a 3 patient case series on the Use of Remdesivir in Myasthenia gravis and COVID‐19.
Of the 3 patients, none had evidence of a myasthenia exacerbation. 1 died of a PE and the other 2 were alive at publication.
The author’s concluded:
In these critically ill patients with MG and COVID‐19 pneumonia, the use of the antiviral remdesivir in combination with dexamethasone did not precipitate a MG exacerbation or crisis.
With a rare condition like MG, it is likely that case series like these will remain the only evidence supporting the use of remdesivir in covid-19 patients.
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