A working group of international MG experts has assembled and prepared guidelines of therapy for MG/LEMS patients.

These recommendations have been prepared and endorsed by an international working group of MG experts in response to the COVID-19 pandemic on 23 March 2020. The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) endorsed these recommendations on 25 March 2020.


Corona Virus Disease 2019 (COVID-19) is a new illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms are variable but typically include fever, cough, respiratory symptoms, diarrhea, reduction of smell and taste sensation. Severity ranges from mild to severe and the virus may lead to pneumonia, acute respiratory distress syndrome and death, in some patients. Nearly every country in the world has been affected by this virus and is currently defined as a pandemic, by the World Health Organization. There are no known proven therapies for treating this virus and no vaccine to prevent the infection at this time.

No data currently exist on how COVID-19 affects people with myasthenia gravis (MG)/LEMS or patients with other diseases on immunosuppressive therapies. However, because most patients with MG are on immunosuppressive or immunomodulatory therapies and may also have respiratory muscle weakness, there is a theoretical concern that MG/LEMS patients may be at higher risk of contracting the infection or experiencing severe manifestations of COVID-19.

Individuals with MG and LEMS as well as treating physicians have asked for guidance on the use of therapies during the COVID-19 pandemic. There are numerous recommendations circulating that attempt to provide clarity and guidance, however, differences among the recommendations have created confusion. Immunotherapy decision making varies significantly from country to country, ranging from highly provider-directed to a collaborative decision-making model. The advice below was developed by a panel of MG experts. We recognize that peer reviewed published literature regarding COVID-19 in MG or in immunocompromised patients to date is lacking.

The MG expert panel suggests that therapy decisions should be individualized and made collaboratively between the person with MG and his/her healthcare provider. 


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Journal of the Neurological Sciences