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COVID-19 and Multiple Sclerosis: 2025 Updates

This summary is based on two articles published in the April 2025 issue of The Lancet Neurology: a Personal View by Zabalza et al. and a Comment by Fitzgerald, both exploring the latest insights into how COVID-19 interacts with multiple sclerosis (MS).

Infection Risk & Severity

People with MS are not more likely to catch COVID-19 than others. However, some may face more serious illness—especially those who:

  • Are older or have other health conditions like diabetes or obesity
  • Have more advanced MS or higher disability levels
  • Take certain medications that weaken the immune system (like rituximab or ocrelizumab)

Vaccine Response

Most people with MS respond well to COVID-19 vaccines. But two treatments—anti-CD20 therapies and S1P modulators—can make vaccine responses weaker. Even then:

  • Some protection still exists, especially from T cells (another part of the immune system)
  • Getting the Moderna (mRNA-1273) vaccine gives better antibody levels than Pfizer

Timing Strategies

  • If you’re on an anti-CD20 therapy, getting vaccinated 3+ months after your last dose can help improve your body’s response.
  • Annual booster doses are recommended, especially for people with weaker immune systems.

Long COVID & MS

About 1 in 4 people with MS may develop long COVID—higher than the general population. Common symptoms include:

  • Tiredness
  • Shortness of breath
  • Loss of smell

You may be more likely to get long COVID if you had anxiety, depression, or a high level of disability before infection.

Other Prevention Tools

For people at higher risk:

  • Antiviral medications (like Paxlovid) can help prevent severe illness if taken early.
  • Some older antibody treatments don’t work as well against new variants, but newer options are being studied.
Citations

Zabalza, A., Thompson, A., Rotstein, D. L., Bar-Or, A., & Montalban, X. (2025). Multiple sclerosis and COVID-19: interactions and unresolved issues. The Lancet. Neurology, 24(4), 361–370. https://doi.org/10.1016/S1474-4422(25)00006-7

Fitzgerald K. C. (2025). SARS-CoV-2 infection in people with multiple sclerosis. The Lancet. Neurology, 24(4), 281–282. https://doi.org/10.1016/S1474-4422(25)00069-9