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Original research
COVID-19 has no impact on disease activity, progression and cognitive performance in people with multiple sclerosis: a 2-year study
  1. Federico Montini1,
  2. Agostino Nozzolillo1,
  3. Nicolò Tedone2,3,
  4. Damiano Mistri2,3,
  5. Paola MV Rancoita4,
  6. Chiara Zanetta1,
  7. Alessandra Mandelli5,
  8. Roberto Furlan5,
  9. Lucia Moiola1,
  10. Vittorio Martinelli1,
  11. Maria A Rocca1,2,3,
  12. Massimo Filippi1,2,3,6,7
  13. On behalf of the Clinical SanRaf MS Study Group
  1. 1 Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
  2. 2 Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
  3. 3 Vita-Salute San Raffaele University, Milano, Italy
  4. 4 University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy
  5. 5 Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
  6. 6 Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy
  7. 7 Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
  1. Correspondence to Professor Massimo Filippi, Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit; Neurorehabilitation Unit; and Neurophysiology Unit, IRCCS Ospedale San Raffaele, Milano, 20132, Italy; filippi.massimo{at}hsr.it

Abstract

Background Sequelae of COVID-19 in people with multiple sclerosis (PwMS) have not been characterised. We explored whether COVID-19 is associated with an increased risk of disease activity, disability worsening, neuropsychological distress and cognitive dysfunction during the 18–24 months following SARS-COV-2 infection.

Methods We enrolled 174 PwMS with history of COVID-19 (MS-COVID) between March 2020 and March 2021 and compared them to an age, sex, disease duration, Expanded Disability Status Scale (EDSS), and a line of treatment-matched group of 348 PwMS with no history of COVID-19 in the same period (MS-NCOVID). We collected clinical, MRI data and SARS-CoV2 immune response in the 18–24 months following COVID-19 or baseline evaluation. At follow-up, PwMS also underwent a complete neuropsychological assessment with brief repeatable battery of neuropsychological tests and optimised scales for fatigue, anxiety, depression and post-traumatic stress symptoms.

Results 136 MS-COVID and 186 MS-NCOVID accepted the complete longitudinal evaluation. The two groups had similar rate of EDSS worsening (15% vs 11%, p=1.00), number of relapses (6% vs 5%, p=1.00), disease-modifying therapy change (7% vs 4%, p=0.81), patients with new T2-lesions (9% vs 11%, p=1.00) and gadolinium-enhancing lesions (7% vs 4%, p=1.00) on brain MRI. 22% of MS-COVID and 23% MS-NCOVID were cognitively impaired at 18–24 months evaluation, with similar prevalence of cognitive impairment (p=1.00). The z-scores of global and domain-specific cognitive functions and the prevalence of neuropsychiatric manifestations were also similar. No difference was detected in terms of SARS-CoV2 cellular immune response.

Conclusions In PwMS, COVID-19 has no impact on disease activity, course and cognitive performance 18–24 months after infection.

  • COVID-19
  • MULTIPLE SCLEROSIS

Data availability statement

Data are available upon reasonable request. The dataset used and analysed during the current study is available from the corresponding author on reasonable request.

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Data availability statement

Data are available upon reasonable request. The dataset used and analysed during the current study is available from the corresponding author on reasonable request.

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Footnotes

  • Twitter @Nico_Ted1, @lucia65243896

  • Correction notice Since this paper first published, data in table 1 has been updated.

  • Collaborators Clinical SanRaf MS Study Group: Matteo Azzimonti, Bruno Colombo, Giulia D’Amore, Federica Esposito, Laura Ferrè, Angela Genchi, Antonino Giordano, Simone Guerrieri, Mor Gueye, Irene Gattuso, Maria Sofia Martire, Paolo Preziosa and Martina Rubin.

  • Contributors Study concept: MF, MAR. Data acquisition and analysis: FM, AN, NT, DM, PMVR, CZ, AM, RF, LM, VM. Interpretation of data: FM, PMVR, AM, RF, MAR, MF. Statistical analysis: PMVR. Drafting of the manuscript: FM, MAR. Revision of the manuscript: all authors. Guarantor of the study: MF.

  • Funding This study has been partially supported by FISM—Fondazione Italiana Sclerosi Multipla—cod. 2021/C19-R-Single/005 and financed or cofinanced with the '5 per mille' public funding.

  • Competing interests FM, AN, NT, DM, PMVR, CZ, AM and RF have nothing to disclose. LM received compensation for speaking activities, and/or consulting services from Merck, Biogen, Novartis, Roche, Sanof, and TEVA. VM received compensation for speaking and/or for consultancy and support for travel expenses and participation in Congresses from Biogen, Merck-Serono, Novartis, Genzyme and Teva Pharmaceutical Industries. MAR received consulting fees from Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche; and speaker honoraria from AstraZeneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. She receives research support from the MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders. MF is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

  • Provenance and peer review Not commissioned; externally peer reviewed.