COVID-19 infection in NMO/SD patients: a French survey

Abstract

COVID-19 pandemic due to SARS-CoV2 virus is ongoing, with a fatality rate around 5.4% [1]. Neuromyelitis optica spectrum disorders (NMO/SD) is a rare disabling disease requiring immunosuppressive therapy. The risk of severe COVID-19 remains unknown in NMO/SD. The aim of this case-series study is to describe the prevalence and characteristics of COVID-19 in NMO/SD patients. We conducted a monocentric retrospective caseseries study of NMO/SD patients with highly suspected or proven COVID-19. They fulfilled at least one of the three NMO diagnostic criteria sets [2-4] and were registered in the NOMADMUS cohort (gathering data from French expert NMO/SD centers). Among 117 NMO/ SD patients followed in the department of neurology of Pitié Salpêtrière Hospital in Paris, 75 were questioned by phone about COVID-19 infection between 05/05/2020 and 06/15/2020 (33 were lost to follow-up, 9 were unreachable by phone). We collected demographics, neurological history, comorbidities, COVID-19 characteristics and outcome. COVID-19 diagnosis was retained on ≥ 1 of the following criteria was fulfilled: (1) positive SARS-CoV2 PCR (naso-pharyngeal swab) or serology (IgG); (2) typical thoracic ground glass opacities on CT scan; (3) acute anosmia/ageusia of sudden onset in the absence of rhinitis or nasal obstruction; (4) typical triad symptoms (cough, fever, asthenia) in epidemic zone of COVID-19. The study received approval from the ethic committee of Sorbonne University (#CER-2020-19).

The Impact of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorder Beyond Infection Risk

“…Here, although some patients being treated with immunosuppressives (especially MMF and AZA) had lower immune cell counts and immunoglobulin levels than normal, these lower levels were similar to those of patients without treatment. With the preventive measures suggested by the World Health Organization (3), none of these abnormal immune status patients had COVID-19 infections, even patients from the high-risk Hubei area, confirming similar reports (13,15,30) that the risk of COVID-19 infection did not increase in NMOSD patients being treated with immunosuppressants. In fact, infection risk is an ongoing concern for all patients using immunosuppressive therapies even without the COVID-19 pandemic, and our data further support the safe use of immunosuppressive therapies in conjunction with effective preventive approaches in future pandemic scenarios.…”

“…In addition, the immunosuppressive therapy used for NMOSD relapse prevention can also make these patients potential targets for infections by altering their immune systems. Therefore, COVID-19 infection and NMOSD immunosuppressive therapy in these patients during the pandemic have been the focus of previous several studies (12)(13)(14)(15). However, in addition to infection risk, COVID-19 has also influenced other aspects of these patients' lives, including their challenges related to continuous treatment, changes to medical procedures, and mental stresses resulting from the pandemic.…”

COVID-19 susceptibility and outcomes among patients with neuromyelitis optica spectrum disorder (NMOSD): A systematic review and meta-analysis

“…Of these, 67 studies were assessed with full-text review. Finally, 23 studies met the inclusion criteria including 19 published articles ( Alonso et al, 2021 ; Cabal-Herrera and Mateen, 2021 ; Ciampi et al, 2020 ; Creed et al, 2020 ; Fan et al, 2020 ; Friedli et al, 2021 ; Louapre et al, 2020b ; Maillart et al, 2020 ; Mantero et al, 2020 ; Mirmosayyeb et al, 2020 ; Montero-Escribano et al, 2020 ; Parrotta et al, 2020 ; Sahraian et al, 2020 ; Stastna et al, 2021 ; Tomczak and Han, 2020 ; Viswanathan, 2020 ; Woo et al, 2021 ; Yin et al, 2021 ; Zeidan et al, 2021 ) and 4 conference abstracts ( Boaventura et al, 2020 ; Graham et al, 2020 ; Kurihara and Bharat, 2021 ; Mehdipour and Ashtari, 2020 ) reporting 112 NMOSD patients with COVID-19. The search included nine studies on risk of COVID-19 and nine studies on outcome, with a total of 6243 NMOSD patients.…”

Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: A pandemic year in Czechia

“…However, the effect of immunomodulatory therapies on the course of COVID-19 has not been satisfactorily elucidated yet. As for NMOSD, reports on COVID-19 infection are scarce, but the available data (Alonso et al, 2021;Ciampi et al, 2020;Creed et al, 2020;Fan et al, 2020;Louapre et al, 2020b;Sahraian et al, 2020;Zeidan et al, 2020a) indicates a high proportion of hospitalized patients and a high mortality rate among these patients.…”