Determinants of recovery from the coronavirus disease 2019 in people with multiple sclerosis: The UK MS Register COVID-19 prospective cohort study

ABSTRACT

Objective: To assess factors associated with recovery from the coronavirus disease 2019 (COVID-19) among people with multiple sclerosis (pwMS) Background: It is important to understand the recovery process from COVID-19 among pwMS to identify those who are most vulnerable to the long-term sequelae of infection. Design/Methods: The UK MS Register COVID-19 study is a community-based prospective cohort of pwMS launched on March 17th, 2020. We have been collecting data from participants (n=6,618 as of October 5th, 2020) every two weeks from the time of their enrolment in the study. We ask participants about COVID-19 and follow them through their recovery. The UK MS Register holds pre-COVID-19 longitudinal and prospectively collected patient-reported data including web-based Expanded Disability Status Scale (webEDSS), MS Impact Scale (MSIS-29), and Hospital Anxiety and Depression Scale (HADS) scores. Results: Out of 709 participants with self-diagnosed COVID-19, 391 responded to the follow-up questionnaires. 76% (n=297) had fully recovered, 15.9% (n=62) had mostly recovered, and 8.2% (n=32) were still experiencing symptoms at the time of their latest follow-up. Among participants with full recovery, the median (IQR) duration of disease was 10 (6-21) days. Participants who had not recovered completely had been followed up for a median (IQR) duration of 105 (35-131) days. PwMS who had a higher webEDSS score (OR 0.78, 95%CI 0.65-0.93) or physical component of MSIS-29 score (OR 0.97, 95%CI 0.96-0.98) were less likely to report a full recovery. The presence of anxiety (HADS-anxiety ≥11), recorded the year before the pandemic, was associated with a lower probability of complete recovery (OR 0.26, 95%CI 0.10-0.66). Demographics, diseasemodifying therapies, MS duration, or type of MS were not associated with recovery. Conclusions: Physical disability and anxiety prior to the pandemic are the main determinants of persistent COVID-19 symptoms among people with MS.