. 2023 Feb;30(2):399-412.

doi: 10.1111/ene.15613. Epub 2022 Nov 18.

Factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases: Data from the International Neuromuscular COVID-19 Registry

Chiara Pizzamiglio^{1

2}, Robert D S Pitceathly^{1

2}, Michael P Lunn¹, Stefen Brady³, Fabiola De Marchi⁴, Lucia Galan⁵, Jeannine M Heckmann⁶, Alejandro Horga⁵, Maria J Molnar⁷, Acary S B Oliveira⁸, Wladimir B V R Pinto⁸, Guido Primiano^{9

10}, Ernestina Santos¹¹, Benedikt Schoser¹², Serenella Servidei^{9

10}, Paulo V Sgobbi Souza⁸, Vishnu Venugopalan¹³, Michael G Hanna^{1

2}, Mazen M Dimachkie¹⁴, Pedro M Machado¹; Neuromuscular Diseases and COVID-19 Study Group

Collaborators, Affiliations

Collaborators

Neuromuscular Diseases and COVID-19 Study Group:
Albert Lim, Amar Elsaddig, Ana Juanatey, Ana Romeiro, Andreas Themistocleous, Annamaria Kiss-Csenki, Antonio Guerrero Sola, Anuja Patil, Ashish Duggal, Carolyn Gabriel, Charles Marshall, Christopher Record, Claire Allen, David Bearden, DeviPriya Rathna Sabapathi, Dileep R, Domizia Vecchio, Edward Newman, Edwin Eshun, Eng C Foo, Enrico Bugiardini, Georgina Burke, Gita Ramdharry, Gràinne S Gorman, Guru Kumar, Harri Sivasathiaseelan, Igor Braga Farias, Izelle Smuts, James Holt, Jan T Groothuis, Jane Pritchard, Jasmine Wall, Josep Gamez, K J S Shakthi, Kate Wannop, Kathryn Brennan, Lillian Saavedra, Lisa Clayton, Liz Househam, Mariola Skorupinska, Matilde Laura, Matteo Ciocca, Maya Zosmer, Megha Dhamne, Michelangelo Mancuso, Mirian Janssen, Olimpia Musumeci, Olivia Price, Patrick F Chinnery, Philip Ambrose, Puja R Mehta, Rhys H Thomas, Rita Horvath, Robert McFarland, Ross Nortley, Ross W Paterson, Ruth Geraldes, Ryan Keh, Saara Neshuku, Sandhya Sasidharan, Sarath Menon R, Sharika Raga, Simon Rinaldi, Sireesha Yareeda, Soaham Desai, Sridharan Ramaratnam, Stephen Keddie, Taylor Watson-Fargie, Teresinha Evangelista, Valeria Sansone, Victoria Nesbitt, William L Macken, Yavuz Oktay

Affiliations

¹ Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK.
² NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK.
³ Department of Neurology, John Radcliffe Hospital, Oxford, UK.
⁴ Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Novara, Italy.
⁵ Neuromuscular Diseases Unit, Department of Neurology, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
⁶ Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁷ Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary.
⁸ Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
⁹ Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
¹⁰ Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
¹¹ Department of Neurology, Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal.
¹² Department of Neurology, LMU Klinikum, Friedrich-Baur-Institute, Ludwig-Maximilians-University Munich, Munich, Germany.
¹³ Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
¹⁴ Department of Neurology, University of Kansas Medical Centre, Kansas City, Kansas, USA.

PMID: 36303290
PMCID: PMC9874570
DOI: 10.1111/ene.15613

Factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases: Data from the International Neuromuscular COVID-19 Registry

Chiara Pizzamiglio et al. Eur J Neurol. 2023 Feb.

. 2023 Feb;30(2):399-412.

doi: 10.1111/ene.15613. Epub 2022 Nov 18.

Authors

Collaborators

Neuromuscular Diseases and COVID-19 Study Group:
Albert Lim, Amar Elsaddig, Ana Juanatey, Ana Romeiro, Andreas Themistocleous, Annamaria Kiss-Csenki, Antonio Guerrero Sola, Anuja Patil, Ashish Duggal, Carolyn Gabriel, Charles Marshall, Christopher Record, Claire Allen, David Bearden, DeviPriya Rathna Sabapathi, Dileep R, Domizia Vecchio, Edward Newman, Edwin Eshun, Eng C Foo, Enrico Bugiardini, Georgina Burke, Gita Ramdharry, Gràinne S Gorman, Guru Kumar, Harri Sivasathiaseelan, Igor Braga Farias, Izelle Smuts, James Holt, Jan T Groothuis, Jane Pritchard, Jasmine Wall, Josep Gamez, K J S Shakthi, Kate Wannop, Kathryn Brennan, Lillian Saavedra, Lisa Clayton, Liz Househam, Mariola Skorupinska, Matilde Laura, Matteo Ciocca, Maya Zosmer, Megha Dhamne, Michelangelo Mancuso, Mirian Janssen, Olimpia Musumeci, Olivia Price, Patrick F Chinnery, Philip Ambrose, Puja R Mehta, Rhys H Thomas, Rita Horvath, Robert McFarland, Ross Nortley, Ross W Paterson, Ruth Geraldes, Ryan Keh, Saara Neshuku, Sandhya Sasidharan, Sarath Menon R, Sharika Raga, Simon Rinaldi, Sireesha Yareeda, Soaham Desai, Sridharan Ramaratnam, Stephen Keddie, Taylor Watson-Fargie, Teresinha Evangelista, Valeria Sansone, Victoria Nesbitt, William L Macken, Yavuz Oktay

Affiliations

¹ Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK.
² NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK.
³ Department of Neurology, John Radcliffe Hospital, Oxford, UK.
⁴ Department of Neurology and ALS Centre, Translational Medicine, University of Piemonte Orientale, Maggiore Della Carità Hospital, Novara, Italy.
⁵ Neuromuscular Diseases Unit, Department of Neurology, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
⁶ Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁷ Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary.
⁸ Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
⁹ Neurophysiopathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
¹⁰ Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
¹¹ Department of Neurology, Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal.
¹² Department of Neurology, LMU Klinikum, Friedrich-Baur-Institute, Ludwig-Maximilians-University Munich, Munich, Germany.
¹³ Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
¹⁴ Department of Neurology, University of Kansas Medical Centre, Kansas City, Kansas, USA.

PMID: 36303290
PMCID: PMC9874570
DOI: 10.1111/ene.15613

Abstract

Background and purpose: Clinical outcome information on patients with neuromuscular diseases (NMDs) who have been infected with SARS-CoV-2 is limited. The aim of this study was to determine factors associated with the severity of COVID-19 outcomes in people with NMDs.

Methods: Cases of NMD, of any age, and confirmed/presumptive COVID-19, submitted to the International Neuromuscular COVID-19 Registry up to 31 December 2021, were included. A mutually exclusive ordinal COVID-19 severity scale was defined as follows: (1) no hospitalization; (2) hospitalization without oxygenation; (3) hospitalization with ventilation/oxygenation; and (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs) for severe outcome, adjusting for age, sex, race/ethnicity, NMD, comorbidities, baseline functional status (modified Rankin scale [mRS]), use of immunosuppressive/immunomodulatory medication, and pandemic calendar period.

Results: Of 315 patients from 13 countries (mean age 50.3 [±17.7] years, 154 [48.9%] female), 175 (55.5%) were not hospitalized, 27 (8.6%) were hospitalized without supplemental oxygen, 91 (28.9%) were hospitalized with ventilation/supplemental oxygen, and 22 (7%) died. Higher odds of severe COVID-19 outcomes were observed for: age ≥50 years (50-64 years: OR 2.4, 95% confidence interval [CI] 1.33-4.31; >64 years: OR 4.16, 95% CI 2.12-8.15; both vs. <50 years); non-White race/ethnicity (OR 1.81, 95% CI 1.07-3.06; vs. White); mRS moderately severe/severe disability (OR 3.02, 95% CI 1.6-5.69; vs. no/slight/moderate disability); history of respiratory dysfunction (OR 3.16, 95% CI 1.79-5.58); obesity (OR 2.24, 95% CI 1.18-4.25); ≥3 comorbidities (OR 3.2, 95% CI 1.76-5.83; vs. ≤2; if comorbidity count used instead of specific comorbidities); glucocorticoid treatment (OR 2.33, 95% CI 1.14-4.78); and Guillain-Barré syndrome (OR 3.1, 95% CI 1.35-7.13; vs. mitochondrial disease).

Conclusions: Among people with NMDs, there is a differential risk of COVID-19 outcomes according to demographic and clinical characteristics. These findings could be used to develop tailored management strategies and evidence-based recommendations for NMD patients.

Keywords: COVID-19; Guillain-Barré syndrome; mitochondrial disease; neuromuscular diseases; outcome.

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Conflict of interest statement

Benedikt Schoser has received consulting/speaker's fees from Argenx, Amicus, Audentes, Avrobio, Dynacure, Sanofi‐Genzyme, Spark and Taysha. Mazen M. Dimachkie serves or has recently served as a consultant for Amazentis, ArgenX, Catalyst, Cello, Covance/Labcorp, CSL‐Behring, EcoR1, Janssen, Kezar, Medlink, Momenta, NuFactor, Octapharma, RaPharma/UCB, Roivant Sciences Inc, RMS Medical, Sanofi Genzyme, Shire Takeda, Scholar Rock, Spark Therapeutics, Third Rock, UCB Biopharma and UpToDate. Lucia Galan has received honoraria as a speaker and advisor from Akcea, Alnylam, Grunenthal, and Pfizer. Mazen M. Dimachkie has received research grants or contracts or educational grants from Alexion, Alnylam Pharmaceuticals, Amicus, Biomarin, Bristol‐Myers Squibb, Catalyst, Corbus, CSL‐Behring, FDA/OOPD, GlaxoSmithKline, Genentech, Grifols, Kezar, Mitsubishi Tanabe Pharma, MDA, the NIH, Novartis, Octapharma, Orphazyme, Ra Pharma/UCB, Sanofi Genzyme, Sarepta Therapeutics, Shire Takeda, Spark Therapeutics, the Myositis Association, UCB Biopharma / RaPharma, Viromed/Healixmith and TMA. Pedro M. Machado has received consulting/speaker's fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB.

Figures

**FIGURE 1**
Distribution of COVID‐19 outcomes for the more significant risk factors. GBS, Guillain–Barré syndrome; Mito, mitochondrial disease; MG, myasthenia gravis; mRS, modified Rankin Scale.

See this image and copyright information in PMC

References

1. World Health Organization . WHO Coronavirus (COVID‐19) Dashboard. Accessed January 31, 2022. https://covid19.who.int
1. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid‐19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ. 2020;369:m1985. - PMC - PubMed
1. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID‐19‐related death using OpenSAFELY. Nature. 2020;584(7821):430‐436. - PMC - PubMed
1. Guidon AC, Amato AA. COVID‐19 and neuromuscular disorders. Neurology. 2020;94(22):959‐969. - PubMed
1. Association of British Neurologists . ABN Guidelines. Accessed January 31, 2022. https://www.theabn.org/page/abnguidelines

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Factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases: Data from the International Neuromuscular COVID-19 Registry

Collaborators

Affiliations

Factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases: Data from the International Neuromuscular COVID-19 Registry

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Abstract

Conflict of interest statement

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