Multiple sclerosis (MS) is a chronic condition where the immune system attacks the protective myelin layer that covers your nerves. Worldwide estimates for the number of people in 2020 with MS is 2.8 million, or approximately 35.9 people for every 100,000.

The symptoms of MS can affect processes like sensation, movement, and vision, just to name a few. While some people may have mild disease, others will have a gradually worsening disease that can cause significant disability.

The COVID-19 pandemic has been particularly concerning for people with chronic health conditions, including MS. If you have MS, you may have many questions about your COVID-19 risk, your MS treatment, and the COVID-19 vaccines.

In the article, we cover what people with MS need to know about these topics as well. We will also discuss the steps that you can take to protect yourself from COVID-19.

It doesn’t appear as if people with multiple sclerosis (MS) have an increased risk of contracting COVID-19. However, those with MS may have additional factors — such as older age or medical treatments — that increase their risk for a more serious outcome, should they contract the infection.

What the research has found

A 2021 study of 219 individuals with MS found that the incidence of COVID-19 in this group was actually lower than in the general population. However, the study also found that hospitalization risk was higher in people with MS.

Despite this, illness severity remained low. The study concluded that, compared to the general population, people with MS don’t seem to have a higher risk of contracting COVID-19 or having a severe COVID-19 outcome.

Another 2021 study aimed to identify risk factors for poorer COVID-19 outcomes in 1,626 people with MS. The main risk factor for a worse outcome was a higher level of disability. Other potential risk factors that were identified were:

The mortality rate due to COVID-19 was also higher than that of the general population. However, the researchers note that other medical, societal, and public health issues that they did not investigate could have contributed to this.

A third 2021 study agreed with the findings above. Researchers found that an increased level of disability, older age, and pre-existing health conditions were risk factors for poorer COVID-19 outcomes.

Summary

Overall, it doesn‘t appear as if having MS increases your risk of contracting COVID-19 or of having a serious illness due to COVID-19.

However, there are risk factors that may contribute to a poorer outcome. These include increased disability, older age, and certain other underlying health conditions.

MS is treated with disease-modifying therapy (DMT). These are drugs designed to modify the activity of the immune system and reduce the progression of MS.

Because these drugs affect the immune system, you may wonder if taking them increases your risk of contracting COVID-19 or becoming seriously ill with COVID-19.

There are concerns that some types of DMTs may increase the risk of severe COVID-19.

For example, a 2021 study found that drugs that inhibit CD20, a protein found on certain types of immune cells, could increase a person‘s risk of severe COVID-19. MS drugs in this group include ocrelizumab (Ocrevus) and rituximab (Rituxan).

A 2022 study reviewed 16 observational studies on MS, DMTs, and COVID-19. It found that the use of anti-CD20 drugs may lead to an increased risk of severe COVID-19. However, it did not see an increased risk with other therapy types.

Overall, the National MS Society recommends that people with MS continue taking their DMTs during the pandemic unless directed not to by their doctor. Should you contract COVID-19, it‘s important to discuss DMTs with your doctor or neurologist.

Every individual is different. The potential benefits of adjusting DMT treatment in response to COVID-19 must be weighed against the effect that this could have on a person’s MS.

Summary

It‘s possible that some DMTs, specifically anti-CD20 DMTs, may increase the risk of serious COVID-19. However, other types of MS therapies don‘t appear to increase your risk.

It‘s important to continue taking your DMTs during the pandemic. If you have questions or concerns about your MS medications, be sure to raise them with your doctor.

The best way to protect yourself from COVID-19 is to get vaccinated. Vaccination can not only reduce your risk of contracting COVID-19, but it can also help to prevent serious illness, hospitalization, and death due to COVID-19.

The National MS Society recommends that people with MS get vaccinated as soon as they can. They state that the risk from COVID-19 itself is greater than the potential risks from the COVID-19 vaccines.

COVID-19 vaccines are both effective and safe for people with MS. However, some types of DMTs may reduce the effectiveness of the vaccine. These include:

  • ocrelizumab (Ocrevus)
  • rituximab (Rituxan)
  • alemtuzumab (Lemtrada)
  • ofatumumab (Kesimpta)
  • cladribine (Mavenclad)

If you‘re taking any of the DMTs above, it‘s important to talk with your doctor about your vaccination schedule. It‘s possible that they can recommend a way to better time your COVID-19 vaccine with your DMT to help maximize effectiveness.

COVID-19 vaccine guidelines

As of May 2022, the Centers for Disease Control and Prevention (CDC) recommends that everyone ages 5 and older be vaccinated against COVID-19. Additionally, mRNA vaccines (Pfizer-BioNTech or Moderna) are preferred over adenoviral vector vaccines (Johnson & Johnson)

Recommendations for healthy adults

The current recommendations for COVID-19 vaccines and booster doses in adults are shown in the table below.

Primary series First booster Second booster (age 50 and up)
Pfizer-BioNTech (mRNA) Two doses spaced 3 to 8 weeks apart mRNA booster at least 5 months after primary series mRNA booster at least 4 months after first booster
Moderna (mRNA) Two doses spaced 4 to 8 weeks apart mRNA booster at least 5 months after primary series mRNA booster at least 4 months after first booster
Johnson & Johnson (adenoviral vector) One dose mRNA booster at least 2 months after primary dose mRNA booster at least 4 months after first booster

Recommendations for immunocompromised adults

If you‘re moderately to severely immunocompromised, vaccine recommendations for adults are slightly different. In order to provide better protection, an extra dose has been added to the primary vaccine series. See the table below for details.

NOTE: Having MS and being on a DMT does not necessarily mean you are immunocompromised. However, certain DMTs may increase your risk for COVID-19. Discuss the timing of your vaccinations with your doctor or neurologist.

Primary series (first two doses) Primary series (extra dose) First booster Second booster (age 50 and up)
Pfizer-BioNTech (mRNA) Two doses spaced 3 to 8 weeks apart At least 4 weeks after second dose mRNA booster at least 3 months after primary series mRNA booster at least 4 months after first booster
Moderna (mRNA) Two doses spaced 4 to 8 weeks apart At least 4 weeks after second dose mRNA booster at least 3 months after primary series mRNA booster at least 4 months after first booster
Johnson & Johnson (adenoviral vector) One dose mRNA vaccine dose at least 4 weeks after first dose mRNA booster at least 2 months after primary dose mRNA booster at least 4 months after first booster

Other ways to protect yourself from COVID-19

In addition to getting your COVID-19 vaccine, there are also other ways to protect yourself from contracting COVID-19. These include:

  • asking caregivers and others in your household to get vaccinated
  • washing your hands frequently with soap and water
  • wearing a mask and maintaining physical distancing when you‘re out in public
  • avoiding areas that are very crowded or are poorly ventilated
  • regularly disinfecting high-touch surfaces in your home

MS and COVID-19 vaccine side effects

According to the CDC, the most common side effects of the COVID-19 vaccine include:

  • pain, redness, or swelling at the site of injection
  • fatigue
  • fever
  • chills
  • muscle pain
  • headache
  • nausea

A 2022 study compared the COVID-19 vaccine side effects in people with MS to those of the general population. Overall, it found that side effects were similar between the two groups. The most common side effects in people with MS were:

  • pain at the site of injection
  • fatigue
  • fever
  • headache

Side effects from the COVID-19 vaccine are typically mild and go away on their own in a few days. However, if side effects persist or get worse after a few days have passed, reach out to your doctor.

According to research from 2021, there have been case reports of people with MS experiencing a relapse following COVID-19 vaccination. However, whether or not this was directly caused by the vaccine has not been established.

Per the National MS Society, COVID-19 vaccines are unlikely to lead to a relapse. This is supported by a 2021 study of the Pfizer-BioNTech vaccine in 324 people with MS. The study found that vaccination did not raise short-term risk of relapse. This additional 2021 study also suggested that COVID-19 vaccines did not exacerbate MS or cause MS flares.

Summary

COVID-19 vaccines are effective for people with MS. However, some DMTs may reduce the effectiveness of the vaccine. Talk with your doctor about how to time your vaccine with your medications.

The COVID-19 vaccines are also safe, with side effects in people with MS being similar to those in the general population. It‘s unlikely that vaccination will lead to an MS relapse.

If you do contract COVID-19, there are some medications that the Food and Drug Administration (FDA) has authorized to help limit the severity of the illness. You can use these medications along with at-home care as you recover.

Antiviral medications like nirmatrelvir/ritonavir (Paxlovid) and remdesivir (Veklury) can reduce the virus‘s ability to multiply in your body.

Monoclonal antibody treatments like bebtelovimab can boost your immune system‘s response to the virus.

You may have heard of another monoclonal antibody treatment, casirivimab/imdevimab (REGEN-COV), as well. However, the FDA has limited its use because it is less effective against the Omicron variant.

Is it safe to use COVID-19 medications if you have MS?

If you have MS, talk with your doctor before using any of these medications to treat COVID-19. They can let you know if the medications are safe to use with your DMTs.

People with MS aren’t at an increased risk of contracting COVID-19. However, some factors may put them at a higher risk of serious illness. These include:

  • taking certain types of DMTs, specifically anti-CD20 DMTs
  • having an increased level of disability
  • being an older age
  • having other underlying health conditions like obesity and cardiovascular disease

The best way to avoid serious illness due to COVID-19 is to get a COVID-19 vaccine, which is safe and effective for people with MS. mRNA vaccines are preferred over adenoviral vector vaccines.

Because some DMTs may make the vaccine less effective, talk with your doctor about finding an optimal schedule for your vaccine and MS medications. They can also answer any questions you have related to vaccination for COVID-19.