Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

https://doi.org/10.1016/j.jns.2020.117230Get rights and content

Highlights

  • Majority of patients with chronic autoimmune neurological disorders(cAND’s) likely have mild-to-moderate COVID-19.

  • Patients with cAND’s who had COVID-19, 33% were hospitalized 12.1% required intensive care unit stay and 8.5% died.

  • Immunosuppressive therapies did not appear to have a significant impact on overall infection risk.

Abstract

Objective

To study the risk of acquiring Corona Virus Disease 2019 (COVID-19) and its outcomes in patients on immunosuppressive therapy (IST) for chronic autoimmune neuromuscular disorders (aNMD) and multiple sclerosis (MS).

Methods

We used TriNetX, a global health collaborative clinical research platform collecting real-time electronic medical records data, which has one of the largest known global COVID-19 database. We included patients with chronic autoimmune neuromuscular disorders (aNMD) [myasthenia gravis (MG), inflammatory myositis, and chronic inflammatory neuropathies (CIN)] and MS, based on the International Classification of Disease-10 (ICD-10) coding for one year before January 20th, 2020. We examined the use of IST, rate of COVID- 19, hospitalization, intubation, and mortality among the patients with aNMD and MS.

Results

A total of 33,451 patients with aNMD and 42,899 patients with MS were included. Among them, 111 (0.33%) patients with aNMD and 115 patients (0.27%) with MS had COVID-19. About one third of them required hospitalization. IST did not appear to have a significant impact on overall infection risk in either group; however, risk of hospitalization for immunosuppressed patients with aNMD was higher (Odds ratio 2.86, p-value 0.011).

Conclusions

IST use does not appear to make patients with aNMD and MS more vulnerable to COVID-19. IST may 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 physician reported registry-based data is needed to further confirm these findings.

Keywords

COVID-19
Multiple sclerosis
Neuromuscular disorders
Autoimmune disease
Immunosuppressive therapies
Neurological disorders

Cited by (0)

1

Contributed equally to the manuscript.

View Abstract