Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network

Solé, Guilhem; Salort‐Campana, Emmanuelle; Péreón, Yann; Stojkovic, Tanya; Wahbi, Karim; Cintas, Pascal; Adams, Diana; Laforêt, Pascal; Tiffreau, V.; Desguerre, Isabelle; Pisella, Lucie I.; Molon, Annamaria; Attarian, Shahram

doi:10.1016/j.neurol.2020.04.004

Cited by 80 publications

(128 citation statements)

References 34 publications

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“…Patients with Neuromuscular disorders registered a 41% increase in lethality. The pathophysiological mechanisms related to this association could be: (i) the fact that patients with this precondition are under the use of immunosuppressive therapies and therefore more likely to increase the severity of COVID-19 infection [39]; and (ii) risk of exacerbation of myasthenia gravis and QT prolongation in patients with pre-existing cardiac involvement secondary to the treatment with hydroxychloroquine and azithromycin [40]. However, given that the present database did not provide the patient-specific pharmacological therapies, this question remains open.…”

Section: Discussionmentioning

confidence: 99%

The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases

Nogueira

Nobre

Costa

et al. 2020

JCM

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Background: It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. Methods: A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. Results: A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56–60) years, OR = 6.01; (61–65) years, OR = 10.5; (66–70) years, OR = 20.4; (71–75) years, OR = 34; (76–80) years, OR = 50.9; (81–85) years, OR = 70.7; (86–90) years, OR = 83.2; (91–95) years, OR = 91.8; (96–104) years, OR = 140.2, ref = (0–55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. Conclusions: Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.

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Section: Discussionmentioning

confidence: 99%

The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases

Nogueira

Nobre

Costa

et al. 2020

JCM

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“…To guarantee a fair provision of intensive care to NMD patients, the NMD specialist should establish a close collaboration with respiratory and intensive care specialists. As there is great variability among NMD patients in terms of prognosis, treatability, and disease stage, these patients should not be denied life-saving treatments only based on their disability and without consultation with a neurologist or NMD specialist [45]. To facilitate decisions in case neurological consult is not promptly available, the French Rare Health Care for Neuromuscular Disorders Network developed a list of neuromuscular diseases usually carrying a good prognosis, that could be eligible for admission in ICU, and, for other conditions not on the list, criteria suggesting a favorable outcome in case of ICU admission [45].…”

Section: Sars-cov-2 Infection In Nmd Patientsmentioning

confidence: 99%

“…Conditions with a good prognosis for recovery include autoimmune and congenital myasthenia, metabolic myopathies, inflammatory myopathies without severe systemic damage (in particular, pulmonary fibrosis), muscle channelopathies, and most neuropathies, hereditary or acquired [45]. The positive criteria for a good prognosis for intensive care in these patients are no major cardiac or respiratory damage and no major disability.…”

Section: Sars-cov-2 Infection In Nmd Patientsmentioning

confidence: 99%

Management of patients with neuromuscular disorders at the time of the SARS-CoV-2 pandemic

et al. 2020

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The novel Coronavirus disease-19 (COVID-19) pandemic has posed several challenges for neuromuscular disorder (NMD) patients. The risk of a severe course of SARS-CoV-2 infection is increased in all but the mildest forms of NMDs. High-risk conditions include reduced airway clearance due to oropharyngeal weakness and risk of worsening with fever, fasting or infection Isolation requirements may have an impact on treatment regimens administered in hospital settings, such as nusinersen, glucosidase alfa, intravenous immunoglobulin, and rituximab infusions. In addition, specific drugs for SARS-CoV2 infection under investigation impair neuromuscular function significantly; chloroquine and azithromycin are not recommended in myasthenia gravis without available ventilatory support and prolonged prone positioning may influence options for treatment. Other therapeutics may affect specific NMDs (metabolic, mitochondrial, myotonic diseases) and experimental approaches for Coronavirus disease 2019 may be offered "compassionately" only after consulting the patient's NMD specialist. In parallel, the reorganization of hospital and outpatient services may change the management of non-infected NMD patients and their caregivers, favouring at-distance approaches. However, the literature on the validation of telehealth in this subgroup of patients is scant. Thus, as the first wave of the pandemic is progressing, clinicians and researchers should address these crucial open issues to ensure adequate caring for NMD patients. This manuscript summarizes available evidence so far and provides guidance for both general neurologists and NMD specialists dealing with NMD patients in the time of COVID-19.

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“…Although there are currently no evidence-based guidelines for the management of neuromuscular disease in the current COVID-19 pandemic, there have been recommendations made by the French Rare Health Care for Neuromuscular disease Network (FILNEMUS) as well as recommendations made in a recent review article in Neurology by Guidon and Amato. 5,39 Proposed treatment strategies for initiating and managing immunosuppressants in neuromuscular patients are summarized in Table 3.…”

Section: Management Considerations In Neuromuscular Patients Receivinmentioning

confidence: 99%

Neuromuscular Complications in COVID-19: A Review of the Literature

Pike-Lee

Wolfe

2020

rrnmf

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Coronavirus disease of 2019 (COVID-19) belongs to the betacoronavirus family which is known to cross species barriers and lead to high pathogenicity. There is rapidly growing evidence that COVID-19 infection can be associated with neuromuscular complications. A comprehensive literature review was conducted evaluating articles published related to neuromuscular complications in COVID-19. In this review we focus our discussion on two ways that COVID-19 critically impacts neuromuscular medicine: (1) serious complications and outcomes associated with the viral infection and; (2) management considerations for neuromuscular patients on immunotherapies during the COVID-19 pandemic.

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Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network

Abstract: In France, the epidemic phase of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in February 2020 and resulted in the implementation of

Cited by 80 publications

References 34 publications

The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases

The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases

Management of patients with neuromuscular disorders at the time of the SARS-CoV-2 pandemic

Neuromuscular Complications in COVID-19: A Review of the Literature

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