#AANAM – COVID-19 Often Leads to Flares in MS Patients, Survey Finds

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by Marisa Wexler MS |

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COVID-19 and MS

Editor’s note: The Multiple Sclerosis News Today team is providing in-depth coverage of the 2021 Virtual AAN Annual Meeting, April 17–22. Go here to read the latest stories from the conference.

The majority of people with multiple sclerosis (MS) experience new or worsening symptoms after developing COVID-19, a patient survey indicates.

These findings also suggest that MS patients who are physically disabled or struggle with anxiety or depression are less likely to fully recover from COVID-19.

Healthcare providers caring for MS patients “should be aware that [they] will see patients with persisting COVID symptoms [and] exacerbation of their MS following COVID-19,” said Afagh Garjani, MD, with the University of Nottingham, who presented the findings at the 2021 American Academy of Neurology annual meeting.

Garjani’s talk was titled, “Recovery from COVID-19 in People with Multiple Sclerosis.”

Since the emergence of COVID-19 in late 2019, researchers and clinicians have been working to understand who is at greatest risk from the disease. Last March, researchers launched the UK MS Register COVID-19 study to assess the impact of COVID-19 on people with MS.

Now more than a year old, this is a prospective study — meaning researchers have continually asked MS patients who are taking part to report on their COVID-19 status.

Nearly 8,000 people have participated in the register, and there have been over 1,000 reported cases: 338 confirmed cases of COVID-19, as well as 757 self-reported cases. Among all these cases, 598 patients responded to follow-up questionnaires.

Using these data, “we asked a simple question: how long does it take for people with MS to recover from COVID-19 symptoms?” Garjani said.

More than three-quarters (77%) of these responding patients reported recovering from COVID-19, meaning they were no longer experiencing any of its symptoms. The median time to recovery was 10 days, and ranged from six to 21 days.

Among the patients who had not yet recovered from COVID-19 symptoms, the median follow-up time was 91 days (about three months). Some patients had been experiencing symptoms for as long as 196 days (about 6.5 months).

“These findings are generally similar to what we see in the general population,” Garjani said.

Garjani and colleagues used statistical analyses to look for factors that were significantly associated with whether or not a person would report a full recovery from COVID-19.

These analyses revealed that MS patients with greater disability — as evidenced by higher scores on the Expanded Disability Status Scale (EDSS) — were significantly less likely to make a full recovery.

In addition, individuals who had reported substantial anxiety or depression (assessed with the Hospital Anxiety and Depression Scale) in the year before the pandemic were also significantly less likely to fully recover from COVID-19.

Garjani noted that this finding underscores the importance of mental health on the physical well-being of people with MS — which has long been known, but is often under-recognized and under-discussed.

Neither demographics, disease-modifying therapies (DMTs), MS duration, nor type of MS were associated with worse COVID-19-related outcomes in the analysis. Treatment with steroids also was not associated with altered risk of recovery.

Garjani noted that treatment with a particular kind of DMT called interferon-beta (sold as Rebif and others) was tied with a slightly faster time to recovery, compared to treatment with other DMTs. But, she said, “this faster recovery was only a couple of weeks, and the clinical relevance is questionable.”

To more fully understand how people with MS experience COVID-19 recovery, the next question Garjani and colleagues addressed was: “how does infection affect MS symptoms?”

They found that more than half (58%) of MS patients who developed COVID-19 experienced an exacerbation following infection. That is, their existing MS symptoms got worse, and/or they developed new symptoms.

Statistical analyses revealed that patients who were taking DMTs were significantly less likely to experience new symptoms after COVID-19, while individuals with greater disability were significantly more likely to experience a worsening of existing symptoms.

“In general, individual DMTs do not seem to affect recovery from COVID-19, and they might actually prevent new symptoms of MS after the infection,” Garjani said. “So, we have to be cautious about altering treatment or stopping treatment because of a fear of COVID-19.”

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