Outcomes of coronavirus disease 2019 in patients with neuromyelitis optica and associated disorders

Many individuals with rare neuroimmune disorders may be concerned about their risk of COVID-19 and whether they are at higher risk of severe disease than those without a rare neuroimmune disorder. Louapre and colleagues conducted a study with those with neuromyelitis optica spectrum disorders (NMOSD) and MOG antibody disease (MOGAD) who had a confirmed diagnosis of COVID-19 or a highly suspected diagnosis of COVID-19. They included 15 patients from 11 centers in France.

5 patients were aquaporin-4 antibody positive, 5 were MOG antibody positive, and 5 were negative for both antibodies. All 15 patients were on some medication to reduce the risk of relapses, which included 9 patients on rituximab, 1 on ofatumumab, 2 on azathioprine, and 3 on mycophenolate mofetil.

The most common COVID-19 symptoms they experienced were weakness/lack of energy (80%), fever (66.7%), cough (46.7%), loss of smell or taste (46.7%) headache (40%), difficulty breathing (40%), and digestive issues (40%). 5 of the 15 patients required hospitalization, with 2 needing oxygen support. All 5 of those who were hospitalized were on rituximab. One patient, a 24-year-old who was on rituximab, was on mechanical ventilation in the ICU for 44 days, and their only reported potential risk factor for severe disease was a BMI of 40. Overall, those who were treated as outpatients were younger, had a lower disability score, and had a longer disease duration than those who needed to be hospitalized. Those who were hospitalized had received a rituximab infusion more recently (median time from last infusion was 3 months) than those who were not hospitalized (5 months).

Dr. Benjamin Greenberg, a member of SRNA’s Board of Directors and Medical and Scientific Council noted: “This paper adds to our understanding of the impact of COVID on our rare disease patient population. While we cannot draw firm conclusions about the relative risk for developing complications from COVID-19, there are trends in the literature associating higher rates of hospitalizations with anti-CD20 therapies (like rituximab). Further research is required to determine if this association is real and if there is a cause for concern in patients taking these medications.” 

You can find more information on COVID-19 and rare neuroimmune disorders on our information page here.