Post-COVID sequelae in people with multiple sclerosis and related disorders: a multicenter cross-sectional study
Authors: Hu Chen , Son Jiyeon , McAlpine Lindsay , Bar-Or Amit , Dahl Megan , Brito Sugeidy Ferreira , Kavak Katelyn , Onomichi Kaho , Perrone Christopher , Riley Claire S. , Song Emily , Walker Elizabeth LS , Guttman Bianca Weinstock , De Jager Philip L. , Longbrake Erin E , Xia Zongqi 
Published: December 2024

AbstractImportanceManagement of long-term consequences after acute COVID-19 in people with multiple sclerosis and related disorders (pwMSRD) is challenging due to overlapping clinical presentations. There have been limited investigations of post-COVID sequelae in pwMSRD.ObjectiveWe assessed whether pwMSRD were more susceptible to post-COVID sequelae when compared to controls.DesignThis cross-sectional study leveraged a multi-center cohort of pwMSRD and controls.SettingA one-time web-based survey was conducted between August and December 2022.ParticipantsOut of the 2,156 participants who consented, the analysis included 1,972 after excluding 184 due to missing data.Main ExposureDiagnosis of MSRD.Main Outcomes and MeasuresWe surveyed 71 symptoms that emerged at least 1 month after the initial acute COVID-19 and were either new onset or worsening from the pre-COVID baseline. We assessed whether each participant experienced (1) ≥1 new symptom, (2) ≥1 worsening symptom from baseline.ResultsThe study included 969 pwMSRD (799 [82.5%] women, mean age 51.8 [SD 12.1] years) and 1,003 controls (796 [79.4%] women, mean age 45.2 [SD 10.3] years). 613 pwMSRD (63.5%) and 614 controls (61.2%) experienced acute COVID-19. Compared to controls, pwMSRD had higher odds of developing a new symptom (OR=1.55; 95%CI=1.22-1.98; p<.01) and experiencing a worsening symptom from baseline (OR=3.39; 95%CI=2.64-4.36; p<.01). PwMSRD were more likely to develop new symptoms involving the pulmonary as well as head, eyes, ears, nose, and throat systems, and have worsening systemic, musculoskeletal, and neuropsychiatric symptoms from baseline. Acute COVID-19 severity mediated >20% of the association between MSRD diagnosis and post-COVID sequelae. In the subgroup of pwMS, having post-COVID sequelae was associated with worse functional disability.Conclusions and RelevanceCompared to controls, pwMSRD experienced an increased risk of post-COVID sequelae involving multiple organ systems. Post-COVID sequelae was associated with greater disability in pwMS. The findings highlighted the importance of recognizing and managing long-term symptoms following acute COVID-19 in this vulnerable population.Key PointsQuestion:Are people with multiple sclerosis and related disorders (pwMSRD) more susceptible to post-COVID sequelae?Findings:In this cross-sectional study that included 969 patients and 1,003 controls, pwMSRD had higher odds of experiencing post-COVID sequelae than controls after acute COVID-19. The association was mediated by the severity of acute COVID-19. Post-COVID symptoms, both new and worsening symptoms from baseline, were associated with worse neurological disability.Meaning:These findings highlight the importance of recognizing and effectively managing post-COVID sequelae in pwMSRD.