Abstract
There is an increasing need for better understanding of the impact of coronavirus disease 2019 (COVID-19) on patients with neuromyelitis optica spectrum disorder (NMOSD). A few pilot studies have investigated COVID-19 infections in NMOSD, but few studies have addressed disease activity and immune status of these patients during the pandemic. We carried out a cross-sectional study to examine immune status, relapses, and COVID-19 infections in a cohort of NMOSD patients using an electronic patient registry (MSNMOBase) for multiple sclerosis and related disorders. An online questionnaire was administered to all NMOSD patients in the registry from January 1, 2011, to June 1, 2020. Clinical demographic characteristics, immune status, relapses, treatments, COVID-19 infections, and preventive measures were evaluated. Of the 752 registered patients, 535 (71.1%) with qualified data were included. A total of 486 used preventive therapies during the pandemic, including mycophenolate mofetil (71.2%), azathioprine (13.3%), and other immunosuppressants (6.4%). Neither median immune cell counts nor immunoglobulin levels (p > 0.05) were significantly different between patients with or without immunosuppression. During the pandemic, no patients were diagnosed with COVID-19, and the majority (>95%) took one or more effective protective measures (e.g., wearing a mask and social distancing). However, a significantly higher annualized relapse rate (ARR) was observed in the 33 patients with treatment interruptions due to the pandemic compared to before it (p < 0.05), whereas ARR changes were not found in patients with continuous treatments or those without treatments (p > 0.05). Interruption frequency was significantly higher in patients with relapses compared to those without (34.9 vs. 15.7%, p < 0.01). For stable NMOSD patients during the pandemic, the risk of relapse due to treatment interruption may be higher than the risk of COVID-19 infection when protective measures are used, and continuous relapse-prevention treatments may be necessary.
Highlights
Ever since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in December 2019, the virus has rapidly spread and caused the global coronavirus disease 2019 (COVID-19) pandemic [1,2,3,4]
In addition to infection risk, COVID-19 has 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
Beginning on June 1, 2020, we conducted an online survey using questionnaires mainly focusing on relapses, treatments, behavioral changes, and COVID-19 infections during the pandemic in neuromyelitis optica spectrum disorder (NMOSD) patients registered in the MSNMOBase, a hospitalbased electronic registry for multiple sclerosis (MS) and related disorders established in 2011 [16,17,18]
Summary
Ever since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in December 2019, the virus has rapidly spread and caused the global coronavirus disease 2019 (COVID-19) pandemic [1,2,3,4] This pandemic has raised health concerns for patients with neuromyelitis optica spectrum disorder (NMOSD), a chronic, relapsing autoimmune disorder of the central nervous system mainly associated with antibodies against aquaporin-4 (AQP4) water channels [5, 6]. In addition to infection risk, COVID-19 has 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 These additional factors may increase NMOSD disease activity, with a profound impact on patient quality of life, to date there are limited data to support this
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