Immunosuppressive therapies and COVID-19 risk in children with neuroimmunological disorders

According to the results of a retrospective survey published in Neurology, immunosuppressive therapies were found not to increase the risk of COVID-19 in children with neuroimmunological disorders.

Patients with inflammatory neuroimmunological diseases are often treated with immunosuppressants. These therapies are associated with decreased cellular and humoral immunological responses against infectious agents, including viruses.

To assess whether the pediatric cohort of patients with neuroimmunological disorders was disproportionately affected by COVID-19, the Spanish Pediatric Neurology Society recruited patients receiving immunosuppressive therapies (n=79) and patients not receiving these therapies (n=74 ). for neuroimmunological diseases from 12 centers. Participants completed the questionnaires between July and August 2020 and were reassessed in April 2021 after face-to-face classes resumed. The questionnaires asked for demographic data, details on neuroimmunological diseases, symptoms of COVID-19 and risk of infection.

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The median age of the cohort of children with neuroimmunological diseases was 13 years (interquartile range [IQR]8-16) years, 55% were girls, 52% were receiving immunosuppressive treatment, 37% were taking vitamin D supplementation, 19% had a significant other with COVID-19, 48% had a significant other was, 28% had a significant other a classmate with COVID-19, and 94% used a protective mask on a daily basis.

A total of 17 children reported confirmed (n=11) or suspected (n=6) COVID-19 infection. COVID-19 occurred with a similar frequency in patients who received or did not receive immunosuppressive therapy (14% vs. 8%; p=0.3085).

Of the 79 patients who received immunosuppressive therapy, 36 had lymphopenia and/or B-cell depletion. There was no evidence of an increased risk of COVID-19 from lymphopenia or B cell depletion (P=1).

The only predictors of COVID-19 risk were living with a person who had confirmed COVID-19 (p<0.001) and low vitamin D blood levels (p=0.03935).

Among children with confirmed or suspected COVID-19, 11 developed upper respiratory tract infections, two had myalgia, one had ageusia, one headache, and one abdominal pain. In addition, eight patients reported fever. A patient was hospitalized for an exacerbation of his opsoclonic-myoclonus syndrome.

During the study period, 20% of the patients reported a relapse of their neuroimmunological disease. The frequency of neurological relapses was similar in patients with and without COVID-19 (18% vs. 21%; P=1).

This study may have been biased by the differences in COVID-19 prevalence across Spain, but the researchers attempted to mitigate potential bias by recruiting the same number of cases and controls from each center.

“In this cohort of children with neuroimmunological disorders, the incidence of COVID-19 was low and unaffected by immunosuppressive therapies,” the researchers concluded.

Disclosure: Several authors declared their affiliation with the industry. For a full list of disclosures, see the original article.


Olivé-Cirera G, Fonseca E, Cantarín-Extremera V, et al. Effects of COVID-19 in immunocompromised children with neuroimmunological disorders. Neurol Neuroimmunol Neuroinflamm. Published online November 10, 2021. doi:10.1212/NXI.0000000000001101

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