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Covid-19 and people with neuromuscular disorders: 

World Muscle Society position and advice

Update 02-04-2020 

Amendments to the original document text 

  1.  What consequences does the risk of Covid-19 infection have for treatments used in people with NMD? Additional advice in this paragraph: 
  • Patients should continue their usual cardiac treatments, including Angiotensin-Converting Enzyme inhibitors and Angiotensin Receptor Blockers. Some inaccurate and misleading information has been circulating regarding a potential harmful effect of these treatments, which has not been supported by any clinical or scientific evidence. 
  1. Can treatments for Covid-19 have effects on neuromuscular disease? Additional advice in this paragraph: 
  • Chloroquine and azithromycin treatment can be used experimentally to treat Covid-19. Especially in combination, they should be carefully monitored in patients with Duchenne Muscular Dystrophy or other myopathies with cardiac involvement, for an increased risk of arrhythmia by prolongation of QT interval. 

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New information and results on Covid-19 of relevance for Neuromuscular disease: 

Cardiac issues: 

  • Evidence is gathering for a clinically significant role of cardiac involvement in morbidity and mortality of Covid-19, and cardiac surveillance is advised in patients with pre-existing cardiomyopathy and /or dysrhythmia. 

Immunosuppressive treatment in patients with neuromuscular disease: 

  • Further literature supports the position of the authors that immunosuppression in inflammatory muscle disease, myasthenia gravis, and peripheral nerve disease should not be discontinued except under specific circumstances and in consultation with the neuromuscular specialist. 

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Websites added for further information

https://treat-nmd.org/ 

https://www.nvk.nl/over-nvk/vereniging/dossiers-en-standpunten/covid-19/document-covid-19?dossie rid=26542080 

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References: 

D’Antiga L. Coronaviruses and immunosuppressed patients. The facts during the third epidemic. Liver Transpl. 2020 Mar 20. doi: 10.1002/lt.25756. [Epub ahead of print] 

https://www.nejm.org/doi/full/10.1056/NEJMsr2005760?query=RP

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the- esc-council-on-hypertension-on-ace-inhibitors-and-ang 

Shaobo Shi, Mu Qin, Bo Shen, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China.JAMA Cardiol. Published online March 25, 2020. doi:10.1001/jamacardio.2020.0950. 

Responsible Authors: 

Maxwell S. Damian, and the Executive Board of the WMS (www.worldmusclesociety.org

April 2nd 2020

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