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

ABSTRACT

Background: Outcomes of coronavirus disease 2019 (COVID- 19) in patients with neuromyelitis optica spectrum disorders (NMOSD) or myelin oligodendrocyte glycoprotein antibodyassociated disease (MOGAD), often treated with immunosuppressive therapies, are still unknown. Objectives: The objective was to describe the clinical characteristics and outcomes of COVID-19 in patients with neuromyelitis optica and associated disorders and to identify the factors associated with COVID-19 severity. Methods: We conducted a multi-center, retrospective, observational cohort study among all French expert centers for neuromyelitis optica and related disorders. Patients with NMOSD or MOGAD included in the study received a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020 and June 30th, 2020. Main outcome was COVID-19 severity score assessed on a 7-point ordinal scale ranging from 1 (not hospitalized with no limitations on activities) to 7 (death). Results: Fifteen cases (mean [SD] age 39.3 [14.3] years, 11 female) were included. Five patients (33.3%) were hospitalized, all receiving rituximab. A 24-year-old patient with positive aquaporine-4 antibody, with obesity as comorbidity, needed mechanical ventilation. Outpatients were receiving anti-CD20 (5), mycophenolate mofetil (3) or azathioprine (3). They were younger (mean [SD] age 37.0 [13.4] years), with a longer disease duration (mean [SD] 8.3 [6.3] years) and had a lower EDSS score (median [range] EDSS 2.5 [0-4]) relative to patients requiring hospitalization (mean [SD] age 44.0 [16.4] years, mean [SD] disease duration 5.8 [5.5] years, median [range] EDSS 4 [0-6.5]). Conclusions: COVID-19 outcome was overall favorable in this cohort. Larger international studies are needed to identify risk factors of severe COVID-19, however we recommend to maintain preventive measures to limit the risk of contamination with SARS-CoV-2 in this immunocompromised population.