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

Afagh Garjani; Rodden M Middleton; Rachael Hunter; Katherine A Tuite-Dalton; Alasdair Coles; Ruth Dobson; Martin Duddy; Stella Hughes; Owen R Pearson; David Rog; Emma C Tallantyre; Roshan das Nair; Richard Nicholas; Nikos Evangelou

doi:10.1016/j.msard.2021.102939

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

Mult Scler Relat Disord. 2021 Jul:52:102939. doi: 10.1016/j.msard.2021.102939. Epub 2021 May 5.

Authors

Affiliations

¹ Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
² Population Data Science, Swansea University Medical School, Swansea, UK.
³ College of Health and Human Science, Swansea University, Swansea, UK.
⁴ Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.
⁵ Preventive Neurology Unit, Queen Mary University London, London, UK.
⁶ Neurosciences, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
⁷ Department of Neurology, Belfast Health and Social Care Trust, Belfast, UK.
⁸ Neurology Department, Swansea Bay University Health Board, Swansea, UK.
⁹ Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.
¹⁰ Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK.
¹¹ Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
¹² Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK.
¹³ Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK. Electronic address: nikos.evangelou@nottingham.ac.uk.

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.

Keywords: COVID-19; Disease modifying therapies; Exacerbation; Infection; Multiple sclerosis.

MeSH terms

COVID-19*
Humans
Immunologic Factors
Multiple Sclerosis*
Prospective Studies
SARS-CoV-2
United Kingdom

Substances

Immunologic Factors