Treating NMOSD During COVID-19


What to know about treating patients with neuromyelitis optica spectrum disorders throughout the COVID-19 pandemic.

June Halper, MSN, APN-C, MSCN, FAAN: We’re dealing with COVID-19 in an era that probably is not quickly going away. Do any of these drugs put the person with NMO [neuromyelitis optica] at any greater risk? Would you consider them immunocompromised in terms of needing a booster or needing more specific attention?

Brian G. Weinshenker, M.D.: Yes, that’s a very good question. COVID-19 has really upended the entire world, and we always have to think of that when we’re making therapeutic decisions. The question is, what does NMO do to COVID-19, and the treatment for NMO do to COVID-19, and also does COVID-19 have any effects directly on NMO? We generally would suggest any COVID-19 vaccines or other vaccines because some of these drugs, like inebilizumab, can make patients very prone to another bacterial infection called meningococcus. We generally want vaccines to be administered before patients start on these treatments. Drugs like inebilizumab, because it blocks the antibody response, likely would cause some impairment in having the vaccine response if it was given afterward, although it’s likely there would be significant immunity. We encourage all patients with neuromyelitis optica to get the COVID-19 vaccine. The good news, a couple of different studies from Europe, Italy, and France suggest that patients with neuromyelitis optica are not more likely to get severe COVID-19 or die of COVID-19 than anyone else. Most patients with NMO, until these new drugs were approved, were receiving rituximab or other drugs. The evidence suggests that there’s minimal, if any, increased risk of getting severe COVID-19 or dying by virtue of being on these treatments. Generally, we recommend that patients with NMO continue on their NMO treatments and don’t stop them because of fears that they may make COVID-19 worse.

June Halper, MSN, APN-C, MSCN, FAAN: Thank you for watching in this NeurologyLive® Cure Connections®. If you enjoyed this program, please subscribe to our e-newsletter to receive upcoming programs and other great content in your inbox.

Transcript edited for clarity.

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