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OBJECTIVE: To describe the clinical characteristics and outcomes of COVID-19 among patients with MG and identify factors associated with COVID-19 severity in MG patients. METHODS: The CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS network (between March 1, 2020, and June 8, 2020), including MG patients with a confirmed or highly-suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a polymerase chain reaction (PCR) test from a nasopharyngeal swab and/or SARS-CoV-2 serology, thoracic computed tomography (CT-scan), or typical symptoms. The main outcome was COVID-19 severity based on location of treatment/management (home, hospitalized in a medical unit, or in an intensive care unit). We collected information on demographic variables, general history, and risk factors for severe COVID-19. Multivariate ordinal regression models were used to identify factors associated with severe COVID-19 outcomes. RESULTS: Among 3,558 MG patients registered in the French database for rare disorders, 34 (0.96%) had COVID-19. The mean age at COVID-19 onset was 55.0 ±19.9 years (mean MG duration: 8.5 ± 8.5 years). By the end of the study period, 28 patients recovered from COVID-19, 1 remained affected, and 5 died. Only high Myasthenia Gravis Foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 (p=0.004); factors that were not associated included gender, MG duration, and medium MGFA classes (≤IIIb). The type of MG treatment had no independent effect on COVID-19 severity. CONCLUSIONS: This registry-based cohort study shows that COVID-19 had a limited effect on most patients, and immunosuppressive medications and corticosteroids used for MG management are not risk factors for poorer outcomes. However, the risk of severe COVID-19 is elevated in patients with high MGFA classes [odds ratio: 102.6 (4.4; 2,371.9)]. These results are important for establishing evidence-based guidelines for the management of MG patients during the COVID-19 pandemic.

Background. The use of anti-CD20 antibodies (RITUXIMAB (RTX)) has been shown to be effective in preventing recurrence of relapses and decreasing disability in the neuromyelitis optica spectrum disorder (NMOSD), particularly in seropositive forms for aquaporin-4 antibodies (AQP4+). In myelin oligodendrocyte glycoprotein antibody disease (MOGAD), there is no consensus on the background treatment and the effectiveness of anti-CD20 is debated. Objective. The primary objective is to compare the clinical efficacy of RTX on relapse risk and disability reduction in NMOSD AQP4+ and MOGAD. The secondary objective is to investigate the efficacy of corticosteroid add-on therapy with RTX in NMOSD. Method. This is a multicentric retrospective study including population of adult patients with NMOSD (AQP4+, MOG+ and double seronegative) in Nouvelle-Aquitaine. The primary endpoint was to compare the time to first relapse after the start of RTX between the NMOSD AQP4+ group and MOGAD group , using survival analysis. The secondary endpoints were changes in the annual relapse rate (ARR) and Expanded Disability Status Scale (EDSS) based on the antibody subtype, as well the intake of corticosteroid add-on therapy with RTX on the risk of relaps. Results. Forty-one NMOSD patients were included: 17 AQP4+, 19 MOG+ and 5 double seronegative. There is no significant difference in the time to first relapse after RTX treatment between the NMOSD AQPQ4+ group and MOGAD (p = 0.51). At 1 year and 2 years of follow-up, respectively 94.1% and 69% of patients were free of relapse in the AQP4+ group; 84% and 66.7% in the MOG+ group. In the MOGAD group, the mean ARR decreases significantly after the onset of RTX (ARR the previous year at 1.95, compared to ARR the first year at 0.16, and the second year at 0.30). MOGAD also improve their disability during follow-up with a decrease in EDSS. Regarding the efficacy of corticosteroids, there is no significant difference in the time to first relaps between the group of NMOSD patients with high dose RTX add-on corticosteroids and those receiving RTX alone. Conclusion. The clinical efficacy of RTX in terms of relapse prevention and disability reduction was not different in patients in the NMOSD AQP4+ group and those in the MOGAD group in our study. Our results also suggest the lack of efficacy of corticosteroid add-on therapy with RTX on the risk of relaps at the start of treatment in NMOSD patients., Introduction. L’utilisation des anticorps anti-CD20 (RITUXIMAB (RTX)) a montré son efficacité sur la prévention des récidives des poussées et la diminution du handicap dans le spectre des neuromyélites optiques (NMOSD), en particulier dans les formes séropositives pour les anticorps anti-aquaporine 4 (AQP4+). Dans les maladies associées aux anti-« Myelin oligodendrocyte glycoprotein » (MOGAD), il n’existe pas de consensus sur le traitement de fond et l’efficacité des anti-CD20 est débattue. Objectif. Premièrement, l’objectif est de comparer l’efficacité clinique du RTX sur le risque de poussée et la diminution du handicap chez les NMOSD AQP4+ et les MOGAD. Deuxièmement, l’objectif est d’étudier l’efficacité d'une corticothérapie adjuvante au RTX dans la NMOSD. Méthode. Il s'agit d'une étude rétrospective multicentrique d’une population de patients adultes NMOSD (AQP4+, MOG+ et double séronégatifs) en Nouvelle-Aquitaine. Le critère de jugement principal était de comparer le délai de survenue d'une poussée après le début du RTX entre le groupe NMOSD AQP4+ et MOGAD, à l’aide d’une analyse de survie. Les critères secondaires étaient l'évolution du taux annuel de poussée (TAP) et de l' « Expanded disability status scale » (EDSS) en fonction du sous-type d'anticorps, ainsi que l'apport d'une corticothérapie adjuvante au RTX sur le risque de poussée. Résultats. Quarante et un patients NMOSD ont été inclus : 17 AQP4 +, 19 MOG+ et 5 double séronégatifs. Il n'existe pas de différence significative sur le délai de survenue d'une poussée après le RTX entre le groupe NMOSD AQPQ4+ et MOGAD (p=0,51). A 1 an et à 2 ans de suivi, il existait respectivement 94,1% et 69% de patients libres de poussée dans le groupe AQP4+; 84% et 66,7% dans le groupe MOG+. Dans le groupe MOGAD, le TAP moyen diminue significativement après le début du RTX (TAP l’année précédente à 1,95, comparativement au TAP la première année à 0,16, et la deuxième année à 0,30). Les MOGAD améliorent également leur handicap lors du suivi avec une diminution de l'EDSS. Concernant l’efficacité des corticoïdes, il n'existe pas de différence significative sur le délai de survenue d'une poussée entre le groupe des patients NMOSD ayant une corticothérapie adjuvante au RTX à forte dose et ceux recevant uniquement le RTX. Conclusion. L’efficacité clinique du RTX en termes de prévention de poussée et de diminution du handicap n’était pas différente chez les patients du groupe NMOSD AQP4+ et du groupe MOGAD dans notre étude. Nos résultats suggèrent également l'absence d’efficacité d'une corticothérapie adjuvante au RTX sur le risque de poussée en début de traitement chez les patients NMOSD.