Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders

Abstract

Objective: Disease-modifying drugs (DMDs) may alter the immune status and thus increase the susceptibility to coronavirus disease 2019 (COVID-19) in patients with MS or neuromyelitis optica spectrum disorders (NMOSD). However, evidence supporting this notion is currently lacking. In this study, we conducted a survey on the risk of COVID-19 in patients with MS and NMOSD.

Methods: The survey was conducted through the Chinese Medical Network for Neuroinflammation. Patients in 10 MS centers from 8 cities including Wuhan were included. Information about MS and NMOSD disease duration and the usage of DMDs were collected. Data of suspected cases of COVID-19 were obtained from hospital visits, questionnaires, and patient self-reporting. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was confirmed through clinical evaluation by a panel of experts in conjunction with chest CT and viral RNA detection.

Results: Eight hundred eighty-two of 1,804 (48.89%) patients with MS and 2,129 of 3,060 (69.58%) patients with NMOSD were receiving DMDs. There were no alterations in the patients' DMD regimen during January 15, 2020, to March 15, 2020, the 3-month period. None of the patients with MS treated with DMDs had COVID-19. However, 2 patients with relapsing NMOSD were diagnosed with COVID-19-related pneumonia. After treatment, both patients recovered from pneumonia and neither patient experienced new attacks due to predisposing SARS-CoV-2 infection in the following 2 months.

Conclusions: No increased risk of COVID-19 infection was observed in patients with MS or NMOSD, irrespective of whether these patients received DMDs. A battery of stringent preventive measures adopted by neurologists to reduce COVID-19 infection in these patients may have contributed to low risk of COVID-19 infection.

Figure 1. Distribution map of hospitals of the Chinese Medical Network for Neuroinflammation (CMNN)

The cities marked red were surveyed for the usage of disease-modifying drugs. The CMNN was founded on February 25, 2018. It is a branch of the China National Clinical Research Center for Neurological Diseases. Until now, members of the CMNN include 47 hospitals from 21 provinces and municipalities in mainland China. The location and number of hospitals are illustrated. CMNN's mission includes consultation for government policy-making, introduction of disease-modifying drugs into the National Reimbursement Drug List, fostering research collaborations, and educating neuroimmunologists.

Figure 2. Distribution map of COVID-19 cases across China and cities and hospitals surveyed (red) for this study

COVID-19 = coronavirus disease 2019.

Figure 3. Proportions of patients with MS in 10 centers from 8 cities surveyed who received disease-modifying drugs and methylprednisolone

COVID-19 = coronavirus disease 2019; NMOSD = neuromyelitis optica spectrum disorder.

Figure 4. Proportions of patients with NMOSD in 10 centers from 8 cities surveyed who received disease-modifying drugs and methylprednisolone

COVID-19 = coronavirus disease 2019; NMOSD = neuromyelitis optica spectrum disorder.