Higher Risk of Long COVID Possible With MS, UK Study Suggests

Nearly a third of multiple sclerosis (MS) patients with COVID-19 experience symptoms that last at least one month, according to a review of of more than 550 infected MS patients in the U.K. who did not need to be hospitalized.

This study’s rate is higher than that reported for the general population in some previous studies, the researchers noted, suggesting that people with MS can be at a greater risk of long-term COVID-19 symptoms, commonly known as post-acute sequelae or “long COVID.”

Higher levels of MS disability, poorer mental health, and female sex were found to be risk factors for long COVID.

These findings highlight the importance of COVID-19 vaccination in this vulnerable population, and they may help in developing approaches to better support MS patients with COVID-19, the researchers added.

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The study, “Recovery From COVID-19 in Multiple Sclerosis: A Prospective and Longitudinal Cohort Study of the United Kingdom Multiple Sclerosis Register,” was published in the journal Neurology: Neuroimmunology & Neuroinflammation.

While having MS does not appear to raise the chances of developing severe COVID-19, some MS-specific factors, such as advanced physical disability, have been reported to contribute to poorer outcomes.

However, whether MS patients are at higher risk of long COVID remains unclear.

Long COVID, typically defined by signs and symptoms that persist for at least one month, often affects multiple organ systems, limiting people’s ability to work or go about daily tasks.

“Understanding the burden of [long COVID] among patients with MS and identifying its risk factors will inform MS rehabilitation services, which are going to deal with the emerging needs of patients with MS who had COVID-19,” the researchers wrote.

These scientists analyzed the course of recovery in MS patients who reported having COVID-19 and looked for potential predictors of long COVID.

Their analyses were part of the UK MS Register COVID-19 study, which has followed nearly 8,000 MS patients since March 17, 2020 — the start of the outbreak in that country — to assess COVID-19 frequency and its outcomes in this patient population.

After reporting symptoms suggestive of COVID-19, study participants were contacted by email (via online questionnaires) every two weeks to reassess symptoms until they reported full recovery.

Here, the researchers analyzed data from 571 participants who reported their status and had not been hospitalized during their recovery — a criteria meant to avoid how hospitalization might influence their recovery.

Results showed that 444 (77.8%) patients reported fully recovering from COVID-19 at their last follow-up, while 127 (22.2%) were still experiencing symptoms after a median of 87 days (nearly three months).

At least 165 (29.7%) patients reported COVID-19 symptoms lasting at least one month, and 69 of them (12.4% of all patients) experienced symptoms for three months or longer.

These rates are higher than those reported for the general population in a study using a similar methodology: 13% of people here experienced symptoms lasting at least one month and 2% had symptoms for three months of more.

In MS patients with long COVID, the symptoms most frequently reported included new or worse fatigue, lower respiratory tract infections, new muscle pain, and gastrointestinal problems.

Notably, more than 82% of patients still reporting symptoms after one month showed non-MS-related symptoms, which supports the COVID-19-related nature of such complications.

After adjusting for potential influencing factors, an Expanded Disability Status Scale (EDSS) score of 7 or higher — reflecting patients with very limited mobility and reliant at least on a wheelchair — anxiety and/or depression before COVID-19 onset, and female sex were significantly associated with a higher risk of long COVID.

Specifically, patients with EDSS scores of 7 or higher were 39% less likely to recover from COVID-19, those with anxiety and/or depression had a 29% lower risk of recovering, and women were 24% less likely to recover than men.

The team noted that these findings are consistent with previous studies linking a greater MS-related disability with worse COVID-19 outcomes, and those reporting mental health issues and female sex as risk factors of long COVID in the general population.

“Other MS-related factors such as disease duration or disease-modifying therapies did not appear to influence recovery from COVID-19,” the researchers wrote.

Study findings highlight that people with MS “are affected by postacute sequelae of COVID-19,” and that “preexisting severe neurologic impairment or mental health problems appear to increase this risk,” the researchers wrote.

These results may help to tailor post-COVID-19-rehabilitation for MS patients, they added, and emphasize “the importance of vaccination against COVID-19 in the MS population who appear to be vulnerable to the long-term effects of infection.”

Among study limitations was the fact that a COVID-19 diagnosis was confirmed by laboratory testing in only a proportion of participants, since widespread testing was not available in the U.K. at the time of recruitment.

Future studies, using control groups from both the general population and MS patients without COVID-19, are needed to determine the risk of long COVID in people with MS, the scientists advised.