Immunosuppressive Therapies and COVID-19 Risk in Children With Neuroimmunologic Disorders

Doctor’s hands in protection gloves putting COVID-19 test swab into kid’s mouth in hospital.
In a retrospective survey, researchers assessed whether children receiving immunosuppressive therapies for neuroimmunologic diseases were disproportionately affected by COVID-19.

Immunosuppressive therapies were not found to increase the risk for COVID-19 among children with neuroimmunologic disorders, according to findings of a retrospective survey published in Neurology.

Patients with inflammatory neuroimmunologic diseases are frequently treated with immunosuppressant drugs. These therapies are associated with decreased cellular and humoral immunologic responses against infectious agents including viruses.

To assess whether the pediatric cohort of patients with neuroimmunologic diseases have been disproportionately affected by COVID-19, the Spanish Pediatric Neurology Society recruited patients who were receiving immunosuppressant therapies (n=79) and patients who were not receiving these therapies (n=74) for neuroimmunologic diseases from 12 centers. Participants responded to questionnaires between July and August 2020 and were reassessed in April 2021 after in-person school was reinstated. The questionnaires surveyed demographics, neuroimmunologic disease details, symptoms of COVID-19, and infection risks.

The cohort of children with neuroimmunologic diseases were aged median 13 (interquartile range [IQR], 8-16) years, 55% were girls, 52% were receiving immunosuppressive treatment, 37% used vitamin D supplementation, 19% had a cohabitant with COVID-19, 48% had a cohabitant who was an essential worker, 28% had a classmate with COVID-19, and 94% used a protective mask daily.

A total of 17 children reported a confirmed (n=11) or suspected (n=6) COVID-19 infection. COVID-19 occurred at a similar rate among patients receiving or not receiving immunosuppressive therapy (14% vs 8%; P =.3085), respectively.

Among the 79 patients receiving immunosuppressive therapy, 36 exhibited lymphopenia and/or B-cell depletion. There was no evidence to suggest lymphopenia or B-cell depletion increased risk for COVID-19 (P =1).

The only predictors for COVID-19 risk were cohabitation with a person who had confirmed COVID-19 (P <.001) and low vitamin D blood levels (P =.03935).

Among the children with confirmed or suspected COVID-19, 11 developed upper respiratory tract infections, two had myalgia, one ageusia, one headache, and one abdominal pain. In addition, eight patients reported fever. One patient was admitted to the hospital due to an exacerbation of their opsoclonus myoclonus syndrome.

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

This study may have been biased by the differences COVID-19 prevalence across Spain, however, 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 neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Olivé-Cirera G, Fonseca E, Cantarín-Extremera V, et al. Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders. Neurol Neuroimmunol Neuroinflamm. Published online November 10, 2021. doi:10.1212/NXI.0000000000001101