Long COVID among people with MS: A prospective and longitudinal observational study of the UK MS Register

Introduction: Neurological symptoms of COVID-19 such as fatigue and cognitive and mental health problems constitute the most common long-lasting symptoms of the infection (long COVID) and are also prevalent in MS. Objectives: To assess the prevalence of and factors associated with long COVID in people with MS (pwMS). Aims: To understand how pwMS are affected by long COVID. Methods: This is an ongoing prospective and longitudinal community- based observational study in a national cohort of pwMS who have been reporting whether they have had symptoms suggestive of COVID-19 using the online questionnaire-based platform of the UK MS Register (UKMSR) since 17/03/2020. PwMS with COVID-19 have been regularly followed up to update their recovery status. Here, we report the findings until 19/03/2021. The UKMSR holds demographic and clinical data of registered pwMS and their pre-COVID-19 web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores (HADS scores ≥11 were considered as probable anxiety or depression), which allowed us to examine the effects of these variables on recovery from COVID-19 using multivariable Cox regression analysis. The results will be updated prior to ECTRIMS 2021. Results: Out of 1,096 pwMS with COVID-19, 599 updated their recovery status (participants);their median (interquartile range) age was 50 (41-57) years and 462 (77.1%) were women. 458 participants (76.5%) reported full recovery and 141 participants (23.5%) had persistent symptoms at their last follow-up. At least 181 participants (31.1%) had persistent symptoms for ≥4 weeks and 76 (13.1 %) for ≥12 weeks. Participants with higher web- EDSS scores (adjusted Hazard Ratio: 95% Confidence Interval, 0.92: 0.86-0.98), participants with anxiety and/or depression (0.70: 0.53-0.92), and women (0.78: 0.63-0.97) were less likely to recover from COVID-19. Taking DMTs was not associated with recovery from COVID-19 (0.92: 0.74-1.14). Conclusion: The prevalence of long COVID in pwMS appears to be higher than the general population (13.3% ≥4 weeks and 2.3% ≥12 weeks), and those with higher levels of pre-COVID-19 neurological impairment or mental health problems are at higher risk of long COVID. We have previously shown that COVID-19 can also lead to MS exacerbations. These observations indicates that pwMS require individualised pathways for the effective management of their post-COVID-19 rehabilitation.