ABSTRACT
Introduction: Reports of reinfection in immunocompromised patients increased concern regarding multiple sclerosis (MS) patients since they are mostly on immunosuppressant agents. Objective(s): to compare the risk of reinfection between multiple sclerosis (MS) patients and a control group without MS. Aim(s): Measure the rate of possible reinfection among MS patients and control, protection against reinfection, odd of reinfection among those who previously tested positive;and effect of rituximab on the protection Method: In thisretrospective study, data of all SARS-CoV-2 tests (n=793,301) and almost all MS patients (n=10639) in Isfahan province were collected from January 01, 2020 to August 22, 2021. Of the 2196 MS patients and 793,301 persons from the general population who had been tested at least once, 3 control for each MS patient were identified, leaving 1560 MS patients and 4680 controls without MS. We compared the risk of reinfection after 90 days of a primary infection between those with and without a previous positive COVID-19 test. Result(s): 736 (48.2%) MS patients and 2013 (43.0%) control individuals had at least one positive test. A total of 17 (2.3%) and 22 (1.1%) possible reinfections in MS and control groups were observed. The adjusted risk ratio (RR) of infection among previously infected patients compared to uninfected persons in all MS patients was 0.318 (95%CI: 0.188, 0.538), MS patients on rituximab was 0.426 (95%CI: 0.169, 1.070), MS patients on DMTs rather than rituximab was 0.280 (95% CI: 146, 0.537), and control individuals was 0.179 (95%CI: 0.115, 0.279). The estimated protection against reinfection in all MS patients, MS patients on rituximab, MS patients on DMTs rather than rituximab, and controls were 68.2% (46.3%, 81.2%), 57.4% (-0.1%, 83.5%), 71.5% (45.5%, 85.2%), and 82.1% (72.1%, 88.5%), respectively. We found no statistically significant difference in estimated protection (p=0.123) and odd of reinfection (adjusted OR: 2.01 [0.98, 4.08]) between all MS patients and control group.Two patients were hospitalized at first infection but none required hospitalization at reinfection event. Conclusion(s): Prior SARS-CoV-2 infection is protective against reinfection in MS patients. Those on rituximab may be at a greater risk of reinfection. We found no evidence regrading increased risk of severe reinfection compared to the primary infection Further studies are required to assess the risk of the second reinfection among the MS population.