Impact of NMOSD on Women’s Health


Experts in neurology review the occurrence and severity of infections in women and special patient populations with NMOSD and share their thoughts on the use of vaccines to prevent infections.

Michael Yeaman, PhD: In addition to potential off-target effects and adverse events that relate to administering the drugs and monitoring their effectiveness, infection is probably the most common adverse event that we see with the approved therapies. Infections can differ in male vs female patients. Beyond race or ethnicity, do you notice any differences in infection occurrence or severity in female patients compared with male patients in your cohort? Mirla, I’ll start with you and get your experience.

Mirla Avila, MD: I definitely see more UTIs [urinary tract infections] in my female patients. That’s the No. 1 infection that I see. Most of the time, it’s easy to treat. Nothing has been complicated. The second one would be upper respiratory infections. But UTIs are much more frequent in my female population.

Michael Yeaman, PhD: Important point, Mirla. Mitzi, what’s your experience in regard to infectious disease?

Mitzi Williams, MD: My experiences are similar. I certainly see many more UTIs in my female patients. I haven’t seen any differences in severity in my male vs female patients. Of course, upper respiratory infections would be the second most common.

Michael Yeaman, PhD: Michael, have you seen any differences with respect to preventable infections and vaccination in particular in patients of different diversity populations in your cohort?

Michael Levy, MD, PhD: Certainly, some of these medications can predispose patients to infections that we can vaccinate for. Those are easy targets and easy things to prevent because we have good vaccines and we’re well aware of those risks. Some of the emerging infections, even the recent COVID-19 pandemic, posed a question for us regarding these different medications. Because if we haven’t encountered the organism before, we aren’t sure whether these medications pose a risk. I had many phone calls from patients wondering if their medication posed a specific risk for them for COVID-19. Then it becomes a question of risking COVID-19 vs risking an NMO [neuromyelitis optica] relapse, which isn’t a good position to be in. The more we understand about the risk of these medications predisposing to infections, the better.

Michael Yeaman, PhD: Thanks, Michael. Mitzi, have you observed any patterns with respect to patients regarding vaccines in your population?

Mitzi Williams, MD: For our traditional vaccines that have been around for some time, I haven’t seen differences in patterns. As it pertains to COVID-19, there has been a lot of hesitancy in many different groups. I don’t feel like it was necessarily unique to the Black population. There were many questions around how the vaccines were created and who was included in the studies. But I certainly go through the data with my patients. We talk about the trials, who was in the trials, and the results, and then we come to the best decision possible. But vaccine hesitancy, particularly for the COVID-19 vaccine, was something that I saw among many populations.

Michael Yeaman, PhD: Thanks, Mitzi. Mirla, what’s your experience with respect to preventable diseases, and particularly infections and vaccines?

Mirla Avila, MD: My recommendation to my patients is to get vaccines—the preventable ones of course, but also in regard to COVID-19. That being said, I live in Texas, so there has been a large group of people who haven’t. As Mitzi said, it isn’t specific for NMO. People have mistrust and don’t want to get vaccinated. But because most of my patients are concerned that their immune system may be challenged with NMO medications, most of them chose to get vaccinated through the pandemic.

Michael Yeaman, PhD: Thank you, Mirla.

Transcript Edited for Clarity

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