Current and emerging therapeutics for neuromyelitis optica spectrum disorder: Relevance to the COVID-19 pandemic

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) can lead to immobility and bulbar weakness. This, in addition to the older age of onset and the higher rate of hospitalization compared to multiple sclerosis, makes this patient group a potential target for complicated COVID-19 infection. Moreover, many of the commonly used preventive therapies for NMOSD are cell-depleting immunouppsressants with increased risk of viral and bacterial infections. The emergence of several new NMOSD therapeutics, including immune-modulating agents, concurrently with the worldwide spread of the COVID-19 global pandemic call for careful therapeutic planning and add to the complexity of NMOSD management. Altering the common therapeutic approach to NMOSD during the pandemic may be necessary to balance both efficacy and safety of treatment. Selection of preventive therapy should take in consideration the viral exposure risk related to the route and frequency of administration and, most importantly, the immunological properties of each therapeutic agent and its potential impact on the risk of SARS-CoV-2 susceptibility and severity of infection. The impact of the therapeutic agent on the immune response against the future SARS-CoV-2 vaccine should also be considered in the clinical decision-making. In this review, we will discuss the immune response against SARS-CoV-2 and evaluate the potential impact of the current and emerging NMOSD therapeutics on infection risk, infection severity, and future SARS-CoV-2 vaccination. We propose a therapeutic approach to NMOSD during the COVID-19 pandemic based on analysis of the mechanism of action, route of administration, and side effect profile of each therapeutic agent.

An Overview of Vaccine Development for COVID-19

“…As of April 2020, 115 vaccine candidates were included in the international COVID-19 vaccine research and design landscape [ 63 ]. The most crucial candidate vaccines include viral vector vaccines, nucleic acid-based vaccines, aAPC vaccines, viral proteins and live vaccines [ 12 , 20 , 64 , 65 ]. Among all the vaccines in the clinical trial process as options for SARS-CoV-2, the RNA-based vaccines appear to be more effective than other vaccines since large amounts of vaccine are amenable to low-budget development.…”

Hematopoietic Stem Cell Transplantation in Neuromyelitis Optica-Spectrum Disorders (NMO-SD): State-of-the-Art and Future Perspectives

“…The most frequent side effects were infusion reactions [ 47 ]. To date, inebilizumab is under FDA review for approval use in NMOSD [ 52 ].…”

Management of Idiopathic CNS inflammatory diseases during the COVID-19 pandemic: Perspectives and strategies for continuity of care from a South East Asian Center with limited resources.

“…A total of 230 patients were contacted with 15% actually calling in themselves. Patient visits were divided into those that could be converted and supported by virtual visits not fulfilling the definition of telemedicine and those needing a face to face (Abboud et al, 2020;Lee et al, 2020;Malaysia's Telemedicine 1997) (Fig. 1,2,3).…”

“…Globally, National professional bodies (MSIF,ABN etc.) and experts on CNSIDs have issued guidelines or general comments primarily focusing on MS disease-modifying therapies (DMTs) and NMO/ NMOSD/MOGAD care during the time of COVID-19 (Baker et al, 2020;Buonomo and Brescia Morra, 2020;Giovannoni et al, 2020;Brownlee et al, 2020;Giovannoni, 2020;Multiple Sclerosis International Federation 2020;Coles et al, 2020;National MS Society 2020;Guthy Jackson Charitable Foundation 2020;Abboud et al, 2020;Malaysian Clinical Practice 2015). In Asia or South East Asia no such recommendations exists as yet and our center utilized the former documents in addition to WHO, local MOH directives and local expertise for guidance with local adaptation (World Health Organization 2020; Ministry of Health Malaysia 2019).…”