Long-term outcome after COVID-19 infection in multiple sclerosis: a nation-wide multicenter matched-control study

Gabriel Bsteh; Hamid Assar; Christiane Gradl; Bettina Heschl; Maria-Sophie Hiller; Nik Krajnc; Franziska Di Pauli; Harald Hegen; Gerhard Traxler; Fritz Leutmezer; Peter Wipfler; Gudrun Zulehner; Michael Guger; Christian Enzinger; Thomas Berger; AUT-MuSC-19 investigators

doi:10.1111/ene.15477

Long-term outcome after COVID-19 infection in multiple sclerosis: a nation-wide multicenter matched-control study

Eur J Neurol. 2022 Jun 25:10.1111/ene.15477. doi: 10.1111/ene.15477. Online ahead of print.

Authors

Gabriel Bsteh¹, Hamid Assar², Christiane Gradl³, Bettina Heschl⁴, Maria-Sophie Hiller⁵, Nik Krajnc¹, Franziska Di Pauli⁶, Harald Hegen⁶, Gerhard Traxler⁷, Fritz Leutmezer¹, Peter Wipfler⁸, Gudrun Zulehner¹, Michael Guger^{7

9}, Christian Enzinger⁴, Thomas Berger¹; AUT-MuSC-19 investigators

Affiliations

¹ Department of Neurology, Medical University of Vienna, Vienna, Austria.
² Department of Neurology, Kepler University Hospital, Linz, Austria.
³ Department of Neurology, Medical University of St. Pölten, St. Pölten, Austria.
⁴ Department of Neurology, Medical University of Graz, Graz, Austria.
⁵ Department of Neurology, Barmherzige Brüder Hospital, Eisenstadt, Austria.
⁶ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁷ Clinic for Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria.
⁸ Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
⁹ Department of Neurology, Pyhrn-Eisenwurzen Hospital Steyr, Austria.

Abstract

Background: Long-term outcome after COVID-19 in patients with multiple sclerosis (pwMS) is scarcely studied and controlled data are lacking.

Objective: To compare long-term outcome after COVID-19 in pwMS to a matched control group of pwMS without COVID-19.

Methods: We included pwMS with PCR-confirmed diagnosis of COVID-19 and ≥6 months of follow-up available and, as a control group, pwMS matched 1:1 for age, sex, disability level and disease-modifying treatment type.

Results: Of 211 pwMS with COVID-19 (mean age 42.6 years [SD 12.2], 69% female, median EDSS 1.5 [range: 0-7.5], 16% antiCD20), 90.5% initially had a mild COVID-19 course. At follow-up, 70% had recovered completely 3 months (M3) after COVID-19, 83% after 6 months (M6) and 94% after 12 months (M12). Mild initial COVID-19 course was the only significant predictor of complete recovery (odds ratio [OR]: 10.5; p<0.001). Most frequent residual symptoms were fatigue (M3: 18.5%, M6: 13.7%, M12: 7.3%), hyposmia (M3: 13.7%, M6: 5.2%, M12: 1.7%) and dyspnea (M3: 7.1%, M6: 6.6%, M12: 2.8%). Compared to matched controls, fatigue, hyposmia and dyspnea were significantly more frequent at M3 and still slightly at M6, while there was no difference at M12. PwMS with COVID-19 had neither a significantly increased risk for relapses (OR 1.1; p=0.70) nor disability worsening (OR 0.96; p=0.60).

Discussion: Long-term outcome of COVID-19 is favourable in a large majority of pwMS with only a small proportion of patients suffering from persistent symptoms usually resolving after 3-6 months. COVID-19 is not associated with increased risk of relapse or disability.

Keywords: COVID-19; Multiple sclerosis; SARS-CoV-2; long term; outcome.