SARS-COV-2 pandemic poses an imminent threat to humanity and in particular in those people suffering chronic diseases. Immune-mediated disease, as NMOSD and MOGAD, could be at a higher risk of severe forms of COVID-19 both for the disease itself and for immunosuppressive treatments.
To evaluate the prevalence and severity of COVID-19 infection in the NMOSD/MOGAD population in Italy and evaluate possibily risk factors for disease outcomes.
The MS Study Group of the Italian Neurological Society has set up a proactive programme to provide information about COVID-19 in NMOSD/MOGAD patients, using a semistructured survey.
569 NMOSD/MOGAD patients from 40 Italian MS Centres have been censored for COVID-19.
68% (387/569) of the patients were treated with rituximab, 16% (91/569) with azathioprine, 4.4% (25/569) with tocilizumab, 5.4% (31/569) with other therapies and 6.2% (35/569) were untreated or without information.
8/569 patients (1.4%) were diagnosed having confirmed or highly suspected COVID-19: positive rhino-pharyngeal swabs for SARS-CoV-2 were found in 4 out of 6 tested patients.
At the time of data collection, 6 patients recovered, 1 was still hospitalised and, unfortunately, 1 died. Hospitalisation was required for 3 patients.
5/8 (68%) patients were treated with rituximab. There was no evidence of any difference of such a percentage with the one of the overall population (OR=0.78, 95%CI=0.18-3.31, p=0.74).
COVID-19 infection was classified mild in 5, severe in 2 and critical in 1. The main experienced symptoms were fever, cough, fatigue and shortness of breath. 5/8 patients experienced CNS symptoms as headache (3), dizziness (1), anosmia (1) and delirium (1).
1) the prevalence of COVID-19 infection appears low in NMOSD/MOGAD patients (1.9%) with a mortality rate similar to that of the general italian population (12.5% vs 14.3%);
2) no other risk factors for severe course of COVID-19 than those already known emerge;
3) the baseline use of biologics, and in particular anti-CD20 monoclonal antibodies, is not associated with a higher risk of COVID-19 infection and apparently not with worse COVID-19 outcomes
Even if preliminary, these findings suggest a cautious optimism in the care of these autoimmune conditions during the pandemic phase.
The MS Study Group: M Inglese, A Di Sapio, D Vecchio, P Cavalla, A Protti, M Radaelli, S Malagu', A Gajofatto, D Landi, G Marfia, MP Amato, A Lugaresi, C Scandellari, S Bonavita, P Perini, F Rinaldi, D Centonze, S Di Lemme, P Immovilli, U Aguglia, M Zaffaroni, S Montepietra, L Moiola, M Filippi, MT Ferro', M Salvetti, MC Buscarinu, F Granella, M Dotta, M Mirabella, M Lucchini, G De Luca, C Tortorella, C Gasperini, G Maniscalco, D Ferraro, E Cocco, R Bergamaschi, M Ulivelli, P Valentino, M Falcini, L Brambilla, G Lus, M De Riz, M Trojano, P Ragonese, A Bertolotto