Yin Hexiang, Zhang Yao, Xu Yan, Peng Bin, Cui Liying, Zhang Shuyang
Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China.
Front Neurol. 2021 Mar 22;12:657037. doi: 10.3389/fneur.2021.657037. eCollection 2021.
There is an increasing need for better understanding of the impact of coronavirus disease 2019 (COVID-19) on patients with neuromyelitis optica spectrum disorder (NMOSD). A few pilot studies have investigated COVID-19 infections in NMOSD, but few studies have addressed disease activity and immune status of these patients during the pandemic. We carried out a cross-sectional study to examine immune status, relapses, and COVID-19 infections in a cohort of NMOSD patients using an electronic patient registry (MSNMOBase) for multiple sclerosis and related disorders. An online questionnaire was administered to all NMOSD patients in the registry from January 1, 2011, to June 1, 2020. Clinical demographic characteristics, immune status, relapses, treatments, COVID-19 infections, and preventive measures were evaluated. Of the 752 registered patients, 535 (71.1%) with qualified data were included. A total of 486 used preventive therapies during the pandemic, including mycophenolate mofetil (71.2%), azathioprine (13.3%), and other immunosuppressants (6.4%). Neither median immune cell counts nor immunoglobulin levels ( > 0.05) were significantly different between patients with or without immunosuppression. During the pandemic, no patients were diagnosed with COVID-19, and the majority (>95%) took one or more effective protective measures (e.g., wearing a mask and social distancing). However, a significantly higher annualized relapse rate (ARR) was observed in the 33 patients with treatment interruptions due to the pandemic compared to before it ( < 0.05), whereas ARR changes were not found in patients with continuous treatments or those without treatments ( > 0.05). Interruption frequency was significantly higher in patients with relapses compared to those without (34.9 vs. 15.7%, < 0.01). For stable NMOSD patients during the pandemic, the risk of relapse due to treatment interruption may be higher than the risk of COVID-19 infection when protective measures are used, and continuous relapse-prevention treatments may be necessary.
人们越来越需要更好地了解2019冠状病毒病（COVID-19）对视神经脊髓炎谱系障碍（NMOSD）患者的影响。一些试点研究调查了NMOSD患者中的COVID-19感染情况，但很少有研究涉及这些患者在疫情期间的疾病活动和免疫状态。我们进行了一项横断面研究，使用针对多发性硬化症及相关疾病的电子患者登记系统（MSNMOBase），来检查一组NMOSD患者的免疫状态、复发情况和COVID-19感染情况。对登记系统中2011年1月1日至2020年6月1日期间的所有NMOSD患者进行了在线问卷调查。评估了临床人口统计学特征、免疫状态、复发情况、治疗方法、COVID-19感染情况和预防措施。在752名登记患者中，纳入了535名（71.1%）数据合格的患者。在疫情期间，共有486名患者使用了预防性治疗，包括霉酚酸酯（71.2%）、硫唑嘌呤（13.3%）和其他免疫抑制剂（6.4%）。接受免疫抑制和未接受免疫抑制的患者之间，免疫细胞计数中位数和免疫球蛋白水平均无显著差异（>0.05）。在疫情期间，没有患者被诊断出感染COVID-19，并且大多数患者（>95%）采取了一种或多种有效的防护措施（如戴口罩和保持社交距离）。然而，与疫情前相比，因疫情导致治疗中断的33名患者的年化复发率（ARR）显著更高（<0.05），而持续治疗的患者或未接受治疗的患者的ARR没有变化（>0.05）。复发患者的治疗中断频率显著高于未复发患者（34.9%对15.7%，<0.01）。对于疫情期间病情稳定的NMOSD患者，使用防护措施时，因治疗中断导致复发的风险可能高于感染COVID-19的风险，可能需要持续进行预防复发的治疗。
