Chronic Autoimmune Neurological Disorders and Immunosuppression During the COVID-19 Pandemic

Abstract

Background: The corona virus disease 2019 (COVID-19) pandemic has led to uncertainty regarding the best management practice for patients with chronic autoimmune neurological disorders (cANDs) who require immunosuppressive therapies (ISTs). While ISTs are often essential to control cANDs, there is concern that ISTs may make this patient population more susceptible to COVID-19 and related complications. Expert opinion consensus guidelines have emerged during the pandemic but there is a paucity of real-world data on the impact of COVID-19 in cANDs. Methods: We used TriNetX, which is a global health collaborative clinical research platform collecting real-time electronic medical records data, which has the largest known global COVID-19 database. We included patients with cANDs [multiple sclerosis (MS), myasthenia gravis (MG), inflammatory myositis, and chronic inflammatory neuropathies (CIN)], based on ICD-10 coding for one year before January 20th, 2020. We examined the rates of COVID- 19 infection, hospitalizations, intubations and deaths among these patients Findings: A total of 33,451 patients with autoimmune neuromuscular disorders (aNMDs) and 42,899 patients with MS were included. Among them, 111 (0.33%) patients with aNMDs and 115 patients (0.27%) with MS had COVID-19. Risk of COVID-19 was similar among patients with aNMD and MS. About one third of them required hospitalization. Immunosuppression did not appear to impact infection risk overall in either group; however, risk of hospitalization for immunosuppressed patients with aNMDs was higher (Odds ratio 2.86, p-value 0.011). Interpretation: Immunosuppression is unlikely to make patients with cANDs more vulnerable to COVID-19. ISTs can be continued during the pandemic, as previously suggested by expert opinion guidelines. However, it is important to consider individualizing immunotherapy regimens in some cases. Additional longitudinal physician reported registry-based data is needed to further confirm these findings.Funding Statement: None.Declaration of Interests: Dr. Kovvuru, Dr. Nalleballe, Dr. Onteddu, Dr. Sharma, Dr. Jasti, Dr. Kapoor, Dr. Veerapaneni, Dr. Yadala, Dr. Dandu, and Dr. Archer have no conflicts of interest to report. Dr. Nowak reports no conflicts directly related to this work. Dr. Nowak has received research support from the National Institutes of Health (NIH), Genentech, Alexion Pharmaceuticals, argenx, Annexon Biosciences, Ra Pharmaceuticals, Myasthenia Gravis Foundation of America, Momenta, Immunovant, and Grifols. He has served as consultant/advisor for Alexion Pharmaceuticals, argenx, CSL Behring, Grifols, Ra Pharmaceuticals, Immunovant, Momenta and Viela Bio. Dr. Roy reports no conflicts directly related to this work. He has served as a consultant for Alexion Pharmaceuticals. Ethics Approval Statement: The University of Arkansas Institutional Review Board (IRB) deemed this study to be ‘not human subject research’ (global de-identified COVID-19 Research Network data designated for research use), and gave it an exempt status.