DG Alerts
A study published in the Journal of the Neurological Sciences suggests that immunosuppressive therapy use did not make patients with autoimmune neurological disorders (aNMD) and multiple sclerosis (MS) more vulnerable to coronavirus disease 2019 (COVID-19).
“Overall, our findings largely reinforce the proposed guidelines by the expert communities where current immunosuppressive therapy (with a few exceptions) [was] recommended to be continued even during the pandemic,” wrote Sukanthi Kovvuru, University of Arkansas for Medical Sciences, Little Rock, Arkansas, and colleagues.
The findings come from an analysis of the TriNetX COVID-19 Research Network platform, a global platform collecting realtime electronic medical records data from a network of healthcare organizations across the USA and some outside the US territories. A total of 33,451 patients with aNMD (including myasthenia gravis, chronic inflammatory neuropathies, or inflammatory myositis) and 42,899 patients with MS were included in the study. The researchers examined the use of immunosuppressive therapy, rate of COVID-19, hospitalization, intubation, and mortality among this cohort of patients, using data available as of June 15, 2020.
Of the patients, 224 (0.29%) had COVID-19. Approximately one third (74/224) required hospitalization, and 19 (8.5%) died due to COVID-19 or COVID-19 related complications. The COVID-19 cohort consisted of 111 (0.33%) patients with aNMD and 115 patients (0.27%) with MS, whereby two patients with COVID-19 had both MS and aNMD and were included in both groups for comparative analysis. The researchers noted that immunosuppressive therapy did not appear to have a significant impact on overall infection risk in both groups.
However, in the aNMD group, patients on immunosuppression were more likely to be hospitalized (odds ratio [OR], 2.86; confidence interval [CI], 1.27–6.51; P = 0.011). No other significant differences in clinical outcomes were noted between those on immunosuppressive therapy and those who were not in either the aNMD or the MS groups.
While patients with aNMD who were on immunosuppression were at greater risk of hospitalization, the authors acknowledged that unaccounted factors might have played a role. They pointed out that about 10–15% of patients with myasthenia gravis may have uncontrolled disease with bulbar symptoms and respiratory muscle weakness; thus it can be hypothesized that these patients would be more likely to have severe symptomatic COVID-19 secondary to respiratory compromise leading to hospitalization.
“Current evidence examining the impact of COVID-19 on patients with aNMD and MS who are on immunosuppressive therapy is crucial to implement a safe and appropriate management strategy,” the authors wrote. “Our findings, despite the inherent limitations of a large database-based study, can help to address some of the key knowledge gaps in managing these patients and provide important insights into possible risk factors and outcomes.”
Nonetheless, the authors noted that “these findings, albeit important, cannot replace the need for more controlled longitudinal studies to understand the true impact of COVID19 in this complex patient cohort.” They added that such efforts are already underway whereby major databases such as the European Academy of Neurology Neuro COVID-19 registry, Coronavirus and MS Reporting Database are actively gathering data on COVID-19 in this population. “The findings from these databases will help to further validate our observations,” wrote the authors.
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