Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era

Abstract

The ongoing coronavirus (COVID-19) pandemic is a global health emergency of international concern and has affected management plans of many autoimmune disorders. Immunosuppressive and immunomodulatory therapies are pivotal in the management of neuromyelitis optica spectrum disorder (NMOSD), potentially placing patients at an increased risk of contracting infections such as COVID-19. The optimal management strategy of NMOSD during the COVID-19 era remains unclear. Here, however, we examined the evidence of NMOSD disease-modifying therapies (DMTs) use during the present period and highlighted different scenarios including treatment of relapses as well as initiation and maintenance of DMTs in order to optimize care of NMOSD patients in the COVID-19 era.

Keywords: COVID-19; neuromyelitis optica spectrum disorder; pandemic.

Figure 1

Management of a relapse in NMOSD patients during COVID-19 pandemic. *After improvement continue on oral steroids for 3-6 months and consider initiation of disease-modifying therapies in newly diagnosed patients. Abbreviations: CBC, complete blood count; COVID-19, coronavirus disease 2019; CRP, C reactive protein; CT, computed tomography; IVIG, intravenous immunoglobulins; IVMP, intravenous methylprednisolone; NMOSD, neuromyelitis optica spectrum disorder; PLEX, plasma exchange.

Figure 2

Algorithm for initiation and maintenance of DMTs in NMOSD patients during the COVID-19 pandemic. Abbreviations: ABs, antibodies; COVID-19, coronavirus disease 2019; CTX, cyclophosphamide; DMT, disease modifying therapy; IVIG, intravenous immunoglobulins; MMF, mycophenolate mofetil; MTX, methotrexate; NMOSD, neuromyelitis optica spectrum disorder.