High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies.

High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies.

Gervais A,Marchal A,Maillard A,Le Voyer T,Rosain J,Philipot Q,Bizien L,Peel J,Cederholm A,Migaud M,Pons S,Saker K,Laforet P,Aubart M,Gitiaux C,Biggs C,Leon Lopez R,Souvannanorath S,Tard C,Nadaj Pakleza A,Grapperon A,Heming N,Annane D,Verschueren A,Attarian S,Bigaut K,Hankiewicz K,Kouton L,Villar-Quiles R,Cauquil C,Fleury M,Rocher E,Nicolas G,de Paula Estephan E,da Penha Ananias Morita M,Zanoteli E,Saied Z,Rachdi A,Rim A,Belal S,Ben Sassi S,Hübers A,Faure E,Desguerre I,Basse C,Girard N,Béziat V,Pan-Hammarström Q,Hammarström L,Bodansky A,Parent A,Anderson M,DeRisi J,Demeret S,Truffault F,Fort R,Ader F,Wallet F,Abel L,Molina T,Alyanakian M,Le Panse R,Solé G,Cobat A,Landegren N,Casanova J,Puel A,Bastard P,Jouanguy E

Source :

2026 Apr 2

Pmid / DOI:

41959797

Abstract

Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which have been shown to underlie severe viral diseases, including critical COVID-19 pneumonia, in patients without MG. We studied an international cohort of 85 unvaccinated SARS-CoV-2-infected MG patients with no antiviral treatment. Hypoxemic pneumonia occurred in 48 of these patients, including 22 (45.8%) with AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in 14 (29.2%) patients. Six (16.2%) of the remaining 37 patients had AAN-I-IFN, which neutralized both IFN-α2 and IFN-ω in three patients. The risk of hypoxemic pneumonia was greater in MG patients with AAN-I-IFN neutralizing 10 ng/mL of both IFN-α2 and IFN-ω (odds ratio and 95% confidence interval (OR [95% CI]): 12.7 [2.1-78.9], =0. 0010) or IFN-α2 at any dose (4.7 [1.5-15.0], =0.0054) than in those without such autoantibodies. The risk of AAN-I-IFN production was much higher in MG patients than in the general population (28.9 [10.8-77.7], =4.9×10). Fourteen patients had thymoma, which increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6-19.4], =0.0050) and hypoxemic pneumonia (9.2 [1.9-44.2]; =0.0019). Thymoma is, thus, associated with a higher risk of producing AAN-I-IFN, and these autoantibodies are associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.KEYWORDSBiological Sciences, COVID-19, Immunology and Inflammation, autoantibodies, interferons, myasthenia gravis

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