NMOSD and COVID-19
COVID-19 is caused by a novel coronavirus that was first detected in people in China in 2019 and has since spread to other parts of the world. As of 2023, the COVID-19 situation is mostly under control, and many local policies such as the use of masks has been revised. Below are general information on COVID-19 that remains relevant.
Are NMOSD patients at higher risk of getting COVID-19?
Having NMOSD does not increase the chance of contracting COVID-19. However, certain factors associated with MS may increase your risk of complications if you are unfortunately infected, which includes:
- Age 60 or older
- Chronic lung and heart disease, diabetes or cancer
- Significantly restricted mobility, such as being chair or bed-bound most of your day
- Using immunotherapy for NMOSD
Should I stop my medications for NMOSD?
No. You should not stop your NMOSD medications without medical advice. Although immunotherapy for NMOSD will affect the body’s immune system, and increase the risk of complications for those infected with COVID-19, stopping medications without medical advice would significantly increase the risk of disease relapse, which may lead to unnecessary hospitalization and even the need for high-dose steroid treatment.
There are currently two categories of common immunotherapy for NMOSD in Hong Kong:
(1) Immunomodulators that restrict the ability of the immune system to respond to infection and may increase the risk of infections:
- azathioprine
- cyclophosphamide
- mycophenolate mofetil
- tacrolimus
(2) Immunosuppressants that reconstitute the immune system with prolonged depletion of lymphocytes, which may increase the risk of infections:
- rituximab
- satralizumab
If you are using immunotherapy in category (2), you may consult your doctor-in-charge, and discuss the pros and cons of delaying the next treatment course. If you are newly diagnosed with NMOSD and plan to start immunotherapy, you should discuss thoroughly with your doctor-in-charge the pros and cons of the different treatment options.
If you have contracted COVID-19, you should consult your doctor-in-charge on whether it is safe to with-hold your current immunotherapy.
Should I receive the COVID-19 vaccine?
From international and local reports, the use of COVID-19 vaccine is generally safe and effective for people with NMOSD. However, there is lack of specific recommendations for NMOSD patients on the COVID-19 vaccine. Below are sources with guidelines for patients with MS, which is closely associated with NMOSD:
- MS International Federation (MSIF): https://www.msif.org/news/2020/02/10/the-coronavirus-and-ms-what-you-need-to-know/
- National MS Society: https://www.nationalmssociety.org/coronavirus-covid-19-information/multiple-sclerosis-and-coronavirus/covid-19-vaccine-guidance
- HK Government COVID Vaccine Website: https://www.covidvaccine.gov.hk/en/faq