Investigation and Comparison of COVID-19 Severity among Multiple Sclerosis Patients: A National Registry-Based Study

Abstract

Background: The COVID-19 pandemic has impacted populations worldwide, particularly vulnerable groups, like individuals with autoimmune diseases, such as multiple sclerosis (MS). This study examined the effects of COVID-19 on MS patients compared to healthy controls, focusing on symptom severity and hospitalization rates. Objectives: Evaluating the severity of COVID-19 among MS patients in comparison to a healthy control group. Materials & Methods: This case-control study was conducted on 1,203 MS cases from the nationwide MS registry of Iran and 500 healthy controls. Data, including demographics, MS history, treatment details, COVID-19 symptom severity, and hospitalization records, were collected from various healthcare facilities across Iran. Results: The study revealed no significant difference in hospitalization rates between MS patients (11.6) and healthy controls (P=0.877). MS patients were more likely to experience mild COVID-19 symptoms compared to controls, while moderate and severe symptoms were less frequent (P<0.001). Gender did not significantly affect symptom severity within the MS group (P=0.505), but significant differences were noted in the control group, with males more likely to experience severe symptoms (P=0.021). Symptom severity varied significantly across different MS types (P=0.0034), with relapsing-remitting MS patients predominantly experiencing milder symptoms. Higher Expanded Disability Status Scale scores (4.5 and higher) correlated with more severe COVID-19 symptoms (P<0.00001), emphasizing the need for monitoring disabled MS patients. Conclusion: The findings suggest that MS does not significantly increase the risk of severe COVID-19 outcomes compared to the general population. MS-specific factors, including disease type and disability level, may influence COVID-19 severity. Targeted medical care based on individual health profiles is crucial, highlighting the intricate interplay between MS and infectious diseases, like COVID-19. Copyright © 2026 The Author(s); This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC: https://creativecommons.org/licenses/by-nc/4.0/ legalcode.en), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.