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COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

Masoud Etemadifar1, Nahad Sedaghat2, Ali Aghababaee3

  • 1Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Multiple Sclerosis and Related Disorders
|April 2, 2021
PubMed
Abstract

Insights

COVID-19 infection did not increase the risk of acute attacks in relapsing-remitting multiple sclerosis (RRMS) patients. Lymphopenia from COVID-19 may prevent MS relapses by inhibiting autoreactive cell expansion.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Speculation exists that COVID-19 may trigger relapsing-remitting multiple sclerosis (RRMS) exacerbations.
  • Understanding the impact of COVID-19 on MS is crucial for patient management.

Purpose of the Study:

  • To investigate the association between COVID-19 infection and acute Multiple Sclerosis (MS) attacks in RRMS patients within six months post-infection.
  • To compare relapse incidence in RRMS patients who contracted COVID-19 versus those who did not.

Main Methods:

  • A retrospective cohort study compared RRMS patients with (n=56) and without (n=69) COVID-19.
  • Relapse incidence was recorded for six months following COVID-19 contraction.
  • RRMS exacerbation incidence was compared between COVID-19 patients, a control group, and pre-pandemic baseline.

Main Results:

  • A significantly lower incidence rate of RRMS exacerbation was observed in patients who contracted COVID-19 compared to controls (IRR: 0.275; p=0.026).
  • Self-controlled analysis revealed no significant difference in relapse rates before COVID-19 and after infection (p=0.222).
  • Hospitalization severity due to COVID-19 did not alter relapse risk (p=0.710).

Conclusions:

  • COVID-19 contraction does not appear to elevate the risk of acute MS attacks in the short term.
  • Hypothesized mechanism: COVID-19-induced lymphopenia may inhibit autoreactive memory cell expansion, preventing relapses via a bystander effect.
Keywords:
COVID-19Multiple SclerosisRelapsing-Remitting Multiple SclerosisSARS-CoV-2

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