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      COVID-19 Susceptibility and Outcomes among Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD): A Systematic Review and Meta-Analysis

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          Abstract

          Background

          We conducted this systematic review and meta-analysis to assess the risk of coronavirus disease (COVID-19), clinical features and outcome among patients with Neuromyelitis Optica Spectrum Disorder (NMOSD).

          Methods

          We systematically searched PubMed, Scopus, Web of Science, and Embase from December 1, 2019, to July 2, 2021. The gray literature including the references of original studies, review studies, conference abstracts, and WHO COVID-19 database was also searched. We included any type of studies that reported NMOSD patients with COVID-19, prevalence of COVID-19 among NMOSD patients or the infection outcome (hospitalization, intensive care unit [ICU] admission, or mortality).

          Results

          Out of 540 records, a total of 23 studies (19 published articles and 4 conference abstracts) including 112 NMOSD patients with COVID-19 met the inclusion criteria. Nine studies reporting risk of COVID-19 and nine studies on outcome were included in a quantitative synthesis. The pooled prevalence of COVID-19 was 1.2% (95% CI: 0.001%-0.030%; I 2=92%, p<0.001), with hospitalization of 33.7% (95% CI: 23.3-44.8%; I 2=9.1%, p=0.360) with 52.9% on rituximab treatment. ICU admission was 15.4% (95% CI: 7.6%-24.7%; I 2=20.7%, p=0.272) and mortality was 3.3% (95% CI: 0-9.7%; I 2=21.3%, p=0.253). Thirty-eight patients (48.7%) reported at least one comorbidity. The mean age of the included patients was 40.8 (10.63) years, female/male ratio was 3.35:1. The most common COVID-19 symptom was fever (54.5%), followed by fatigue/asthenia (42.9%), headache (41.6%), and cough (40.3%). Four patients developed neurological worsening. The Begg's and Egger's tests showed no evidence of publication bias.

          Conclusion

          The analysis suggests that comorbidity and treatment with rituximab may be risk factors for COVID-19 infection in NMOSD patients.

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          Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

          Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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            Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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              Effective treatment of severe COVID-19 patients with tocilizumab

              Significance In patients with coronavirus disease 2019, a large number of T lymphocytes and mononuclear macrophages are activated, producing cytokines such as interleukin-6 (IL-6), which bind to the IL-6 receptor on the target cells, causing the cytokine storm and severe inflammatory responses in lungs and other tissues and organs. Tocilizumab, as a recombinant humanized anti-human IL-6 receptor monoclonal antibody, can bind to the IL-6 receptor with high affinity, thus preventing IL-6 itself from binding to its receptor, rendering it incapable of immune damage to target cells, and alleviating the inflammatory responses.
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                Author and article information

                Journal
                Mult Scler Relat Disord
                Mult Scler Relat Disord
                Multiple Sclerosis and Related Disorders
                Elsevier B.V.
                2211-0348
                2211-0356
                1 November 2021
                1 November 2021
                : 103359
                Affiliations
                [1 ]Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
                [2 ]Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [3 ]Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
                [4 ]Department of Neurology, Slagelse Hospital & Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
                Author notes
                [* ]Corresponding author: Professor Nasrin Asgari, MD, PhD, DMSc, Department of Regional Health Research, and Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 25.2, 5000 Odense C, Denmark. Tel. +45 6550 3828.
                [#]

                Authors shared last co-author

                Article
                S2211-0348(21)00626-X 103359
                10.1016/j.msard.2021.103359
                8558105
                35158468
                3382ee08-a5c0-4e76-84d1-6cf792ce14dc
                © 2021 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 26 August 2021
                : 22 October 2021
                : 28 October 2021
                Categories
                Article

                neuromyelitis optica spectrum disorder,coronavirus,covid-19,infection,prevalence,outcome

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