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Background and purpose: COVID‐19 continues to challenge neurologists in counseling persons with multiple sclerosis (pwMS) regarding disease‐modifying treatment (DMT) and vaccination. The objective here was to characterize predictors of COVID‐19 outcome in pwMS. Methods: We included pwMS with polymerase chain reaction‐confirmed COVID‐19 diagnosis from a nationwide population‐based registry. COVID‐19 outcome was classified as either mild or severe. Impact of DMT, specifically anti‐CD20 monoclonal antibodies (anti‐CD20), and vaccination on COVID‐19 outcome was determined by multivariate models adjusted for a priori risk (determined by a cumulative risk score comprising age, disability, and comorbidities). Results: Of 317 pwMS with COVID‐19 (mean age = 41.8 years [SD = 12.4], 72.9% female, median Expanded Disability Status Scale = 1.5 [range = 0–8.5], 77% on DMT [16% on anti‐CD20]), 92.7% had a mild course and 7.3% a severe course, with 2.2% dying from COVID‐19. Ninety‐seven pwMS (30.6%) were fully vaccinated. After a median 5 months from vaccination to SARS‐CoV‐2 infection (range = 1–9), severe COVID‐19 occurred in 2.1% of fully vaccinated pwMS compared to 9.5% in unvaccinated pwMS (p = 0.018). A priori risk robustly predicted COVID‐19 severity (R2 = 0.605, p < 0.001). Adjusting for a priori risk, anti‐CD20 treatment was associated with increased COVID‐19 severity (odds ratio [OR] = 3.3, R2 = 0.113, p = 0.003), but exposure to any other DMT was not. Fully vaccinated pwMS showed a significantly decreased risk for severe COVID‐19 (OR = 0.21, R2 = 0.144, p < 0.001). Conclusions: In a population‐based MS cohort, COVID‐19 course is primarily predicted by a priori risk (depending on age, disability, and comorbidities) explaining about 60% of variance. Anti‐CD20 treatment is associated with a moderately increased risk, whereas reassuringly vaccination provides protection from severe COVID‐19. [ABSTRACT FROM AUTHOR]

Background and purpose: Long‐term outcome after COVID‐19 in patients with multiple sclerosis (pwMS) has scarcely been studied, and controlled data are lacking. The objective of this study was to compare long‐term outcome after COVID‐19 in pwMS to a matched control group of pwMS without COVID‐19. Methods: We included pwMS with polymerase chain reaction‐confirmed diagnosis of COVID‐19 and ≥6 months of follow‐up and, as a control group, pwMS matched 1:1 for age, sex, disability level, and disease‐modifying treatment type. Results: Of 211 pwMS with COVID‐19 (mean age = 42.6 years [SD = 12.2], 69% female, median Expanded Disability Status Scale = 1.5 [range = 0–7.5], 16% anti‐CD20), 90.5% initially had a mild COVID‐19 course. At follow‐up, 70% had recovered completely 3 months (M3) after COVID‐19, 83% after 6 months (M6), and 94% after 12 months (M12). Mild initial COVID‐19 course was the only significant predictor of complete recovery (odds ratio [OR] = 10.5, p < 0.001). The most frequent residual symptoms were fatigue (M3: 18.5%, M6: 13.7%, M12: 7.3%), hyposmia (M3: 13.7%, M6: 5.2%, M12: 1.7%), and dyspnea (M3: 7.1%, M6: 6.6%, M12: 2.8%). Compared to matched controls, fatigue, hyposmia, and dyspnea were significantly more frequent at M3 and still slightly more frequent at M6, whereas there was no difference at M12. pwMS with COVID‐19 had neither a significantly increased risk for relapses (OR = 1.1, p = 0.70) nor disability worsening (OR = 0.96, p = 0.60). Conclusions: Long‐term outcome of COVID‐19 is favorable in a large majority of pwMS, with only a small proportion of patients suffering from persistent symptoms usually resolving after 3–6 months. COVID‐19 is not associated with increased risk of relapse or disability. [ABSTRACT FROM AUTHOR]