Post-COVID Conditions in People with Multiple Sclerosis: A Cross-sectional Multicenter Study
Ji Yeon Son1, Chen Hu 2, Lindsay McAlpine3, Amit Bar-Or4, Megan Dahl2, Sugeidy Ferreira Brito1, Katelyn Kavak5, Kaho Onomichi1, Christopher Perrone4, Claire Riley1, Emily Song2, Elizabeth Walker2, Bianca Weinstock-Guttman5, Philip De Jager1, Erin Longbrake3, Zongqi Xia2
1Columbia University Medical Center, 2University of Pittsburgh Medical Center, 3Yale University, 4University of Pennsylvania, 5University At Buffalo School of Medicine and Biomedical Sciences
Objective:
We compared the characteristics, risk factors, and outcomes of post-COVID conditions (PCC) in people with multiple sclerosis (pwMS) with healthy controls and identified relevant risk factors and associated neurological outcomes in pwMS.
Background:
PCC (or long-COVID) is a major public health concern. Diagnosis and management of PCC in pwMS are challenging because both conditions have similar symptoms, including fatigue, cognitive impairment, weakness, and paresthesia.
Design/Methods:
In this cross-sectional, multi-center study, participants completed a one-time web-based survey (Aug-Dec 2022) ascertaining demographics, infections, vaccination status, neurological disease state, post-COVID symptoms (PCS), and MS outcomes. We separately evaluated new and worsening PCS that started 1 month after the initial onset of acute COVID-19 by comparing them to pre-COVID-19 baseline symptoms. We defined PCC as having ≥1 PCS. Descriptive statistics, multivariable regression, and mediation analyses were performed.
Results:
969 pwMS and 1003 controls completed the surveys. 613 pwMS (63.5%) and 614 controls (61.2%) experienced a confirmed or suspected SARS-CoV-2 infection. PwMS had higher odds of developing any new PCS (OR=1.55; 95%CI=1.22-1.98; p=0.0003) and any worsening PCS (OR=3.39; 95%CI=2.64-4.36; p<0.0001). PwMS were more likely to develop new pulmonary and HENT symptoms and worsening systemic, musculoskeletal, and neuropsychiatric symptoms. The development of either new (beta=1.9; 95%CI=0.9-2.9) or worsening (beta=2.9; 95%CI=2.0-3.9) PCS was associated with subsequently worse MS disability (based on the multiple sclerosis rating scale-revised). Among pwMS, women had greater risk for PCC than men. Acute COVID-19 severity mediated 70% of the association between MS diagnosis and PCC.
Conclusions:
Compared to controls, pwMS experienced an increased risk of developing both new and worsening PCS. Careful clinical evaluation to distinguish new versus worsening symptoms in pwMS following acute COVID-19 is crucial. Having PCC in pwMS was associated with greater MS disability, highlighting the importance of recognizing and effectively managing PCC in this vulnerable population.