High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies
Abstract
Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which 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 not given 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, neutralizing 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 to 78.9], P = 0.0010) or IFN-α2 at any dose (OR [95% CI]: 4.7 [1.5 to 15.0], P = 0.0054) than in those without such autoantibodies. The risk of producing AAN-I-IFN was much higher in MG patients than in the general population (OR [95% CI]: 28.9 [10.8 to 77.7], P = 4.9 × 10 −27 ). Thymoma was found in 14 patients and increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6 to 19.4], P = 0.0050) and hypoxemic pneumonia (9.2 [1.9 to 44.2]; P = 0.0019). Thymoma is, thus, associated with a higher risk of producing AAN-I-IFN, which are, in turn, associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.
Related
- From seropositivity to pathogenicity: causal evidence for autoantibodies in myasthenia gravis
- Comprehensive metabolomic characterization of patients with myasthenia gravis
- Identification of rs28362336 as a risk SNP for generalized myasthenia gravis and its impact on HCG27 regulation
- Pathogenic autoantibodies targeting DNA repair proteins are shared by cancer patients and healthy children later diagnosed with cancer
- Autoantibodies from recovered Guillain-Barre syndrome patients exhibit altered effector functions that prevent subsequent neuron degeneration
BibTeX
@article{gervais2026high,
title = {{High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies}},
author = {Adrian Gervais and Astrid Marchal and Alexis Maillard and Tom Le Voyer and Jérémie Rosain and Quentin Philippot and Lucy Bizien and Jessica Peel and Axel Cederholm and Mélanie Migaud and Sylvie Pons and Kahina Saker and Pascal Laforet and Mélodie Aubart and Cyril Gitiaux and Catherine Biggs and Rafael Leon Lopez and Sarah Souvannanorath and Céline Tard and Aleksandra Nadaj Pakleza and Aude-Marie Grapperon and Nicholas Heming and Djillali Annane and Annie Verschueren and Shahram Attarian and Kévin Bigaut and Karolina Hankiewicz and Ludivine Kouton and Rocio-Nur Villar-Quiles and Cécile Cauquil and Marie-Céline Fleury and Emilie Rocher and Guillaume Nicolas and Eduardo de Paula Estephan and Maria da Penha Ananias Morita and Edmar Zanoteli and Zakaria Saied and Amine Rachdi and Amouri Rim and Samir Belal and Samia Ben Sassi and Annemarie Hübers and Emmanuel Faure and Isabelle Desguerre and Clémence Basse and Nicolas Girard and Vivien Béziat and Qiang Pan-Hammarström and Lennart Hammarström and Aaron Bodansky and Audrey Parent and Mark Anderson and Joseph Derisi and Sophie Demeret and Frédérique Truffault and Romain Fort and Florence Ader and Florent Wallet and Sophie Trouillet-Assant and Laurent Abel},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
year = {2026},
month = jul,
doi = {10.1073/pnas.2518581123},
url = {https://hal.science/hal-05750675v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - High risk of hypoxemic COVID-19 pneumonia in myasthenia gravis patients with type I IFN autoantibodies
AU - Adrian Gervais
AU - Astrid Marchal
AU - Alexis Maillard
AU - Tom Le Voyer
AU - Jérémie Rosain
AU - Quentin Philippot
AU - Lucy Bizien
AU - Jessica Peel
AU - Axel Cederholm
AU - Mélanie Migaud
AU - Sylvie Pons
AU - Kahina Saker
AU - Pascal Laforet
AU - Mélodie Aubart
AU - Cyril Gitiaux
AU - Catherine Biggs
AU - Rafael Leon Lopez
AU - Sarah Souvannanorath
AU - Céline Tard
AU - Aleksandra Nadaj Pakleza
AU - Aude-Marie Grapperon
AU - Nicholas Heming
AU - Djillali Annane
AU - Annie Verschueren
AU - Shahram Attarian
AU - Kévin Bigaut
AU - Karolina Hankiewicz
AU - Ludivine Kouton
AU - Rocio-Nur Villar-Quiles
AU - Cécile Cauquil
AU - Marie-Céline Fleury
AU - Emilie Rocher
AU - Guillaume Nicolas
AU - Eduardo de Paula Estephan
AU - Maria da Penha Ananias Morita
AU - Edmar Zanoteli
AU - Zakaria Saied
AU - Amine Rachdi
AU - Amouri Rim
AU - Samir Belal
AU - Samia Ben Sassi
AU - Annemarie Hübers
AU - Emmanuel Faure
AU - Isabelle Desguerre
AU - Clémence Basse
AU - Nicolas Girard
AU - Vivien Béziat
AU - Qiang Pan-Hammarström
AU - Lennart Hammarström
AU - Aaron Bodansky
AU - Audrey Parent
AU - Mark Anderson
AU - Joseph Derisi
AU - Sophie Demeret
AU - Frédérique Truffault
AU - Romain Fort
AU - Florence Ader
AU - Florent Wallet
AU - Sophie Trouillet-Assant
AU - Laurent Abel
PY - 2026
DA - 2026/07/31
JO - Proceedings of the National Academy of Sciences of the United States of America
DO - 10.1073/pnas.2518581123
UR - https://hal.science/hal-05750675v1
AB - Patients with myasthenia gravis (MG) may produce autoantibodies neutralizing type I interferons (AAN-I-IFN), which 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 not given 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, neutralizing 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 to 78.9], P = 0.0010) or IFN-α2 at any dose (OR [95% CI]: 4.7 [1.5 to 15.0], P = 0.0054) than in those without such autoantibodies. The risk of producing AAN-I-IFN was much higher in MG patients than in the general population (OR [95% CI]: 28.9 [10.8 to 77.7], P = 4.9 × 10 −27 ). Thymoma was found in 14 patients and increased the risk of AAN-I-IFN (64% versus 27%, (OR [95% CI]: 5.6 [1.6 to 19.4], P = 0.0050) and hypoxemic pneumonia (9.2 [1.9 to 44.2]; P = 0.0019). Thymoma is, thus, associated with a higher risk of producing AAN-I-IFN, which are, in turn, associated with a higher risk of developing life-threatening COVID-19 pneumonia in patients with MG.
SN - 0027-8424
SN - 1091-6490
ER -