COVID-19 is associated with new symptoms of multiple sclerosis that are prevented by disease modifying therapies

Abstract

Background: Infections can trigger exacerbations of multiple sclerosis (MS). The effects of the coronavirus disease 2019 (COVID-19) on MS are not known. The aim of this study was to understand the impact of COVID-19 on new and pre-existing symptoms of MS. Methods: The COVID-19 and MS study is an ongoing community-based, prospective cohort study conducted as part of the United Kingdom MS Register. People with MS and COVID-19 were invited by email to complete a questionnaire about their MS symptoms during the infection. An MS exacerbation was defined as developing new MS symptoms and/or worsening of pre-existing MS symptoms. Results: Fifty-seven percent (230/404) of participants had an MS exacerbation during their infection; 82 developed new MS symptoms, 207 experienced worsened pre-existing MS symptoms, and 59 reported both. Disease modifying therapies (DMTs) reduced the likelihood of developing new MS symptoms during the infection (OR 0.556, 95%CI 0.316-0.978). Participants with a higher pre-COVID-19 webEDSS (web-based Expanded Disability Status Scale) score (OR 1.251, 95%CI 1.060-1.478) and longer MS duration (OR 1.042, 95%CI 1.009-1.076) were more likely to experience worsening of their pre-existing MS symptoms during the infection. Conclusion: COVID-19 infection was associated with exacerbation of MS. DMTs reduced the chance of developing new MS symptoms during the infection.

COVID-19 susceptibility and outcomes among patients with neuromyelitis optica spectrum disorder (NMOSD): A systematic review and meta-analysis

“…Neurological worsening was reported by 15.4% of infected NMOSD patients ( Boaventura et al, 2020 ; Mantero et al, 2020 ). Recent evidence suggests that COVID-19 may trigger exacerbation of MS ( Barzegar et al, 2021d ; Garjani et al, 2021 ). However, due to short follow-up and absence of control group, it could not be possible to determine the probable association between COVID-19 and risk of relapse in NMOSD patients.…”

Recovery From COVID-19 in Multiple Sclerosis

“… 7 Another study reports a much higher prevalence of prolonged COVID-19 in the general population, but its retrospective data collection could have led to recall bias. 8 Given that MS shares many neurologic symptoms of COVID-19 and that the infection can lead to MS exacerbations, 9 a high prevalence of long-lasting COVID-19 symptoms in this population may seem expected. More than 80% of patients with MS with persistent COVID-19 symptoms in the study, however, also had symptoms that were not typical for MS. Further studies using direct control groups, from both the general population and patients with MS without COVID-19, are needed to establish the risk of PASC in MS.…”

Does COVID-19 increase the long-term relapsing-remitting multiple sclerosis clinical activity? A cohort study

“…It has been hypothesized that coronaviruses can exacerbate/induce MS via different mechanisms, e.g., direct invasion, providing activation signals for autoreactive lymphocytes, and disrupting the blood-brain barrier by inducing the release of pro-inflammatory cytokines [ 18 , 19 ]. Regarding SARS-CoV-2, earlier case studies [ 6 – 9 ] and some population-based evidence [ 10 – 13 ] backed these hypotheses, at least in short-term. However, the present study and another study in the same setting [ 14 ] were not able to confirm any longer-term relationship between COVID-19 and clinical MS activity.…”

“…So far, many real-world studies have been focusing on this issue, most of which addressing MS disease activity during or shortly after COVID-19. Earlier case studies [ 6 – 9 ] and some population-based studies were able to confirm a positive short-term association between COVID-19 and exacerbation of relapsing-remitting MS (RRMS) [ 10 – 13 ]. Although this confirmation was not achieved in a study contributed by the current authors [ 14 ], the mentioned association between COVID-19 and MS disease activity could be well-explained by our current knowledge of their pathophysiology [ 15 ].…”