Low Adherence to Multiple Sclerosis Care Common During COVID-19 Pandemic

Doctor discussing with female patient during COVID-19. Male medical professional is explaining woman while sitting at desk. They are wearing protective face masks in clinic.
While patients with multiple sclerosis are at an overall low risk for severe COVID-19 infection, concern and fear of infection may impact their adherence to care.

During the coronavirus disease (COVID)-19 pandemic, patients with multiple sclerosis (MS) were concerned about the viral infection; additionally, low adherence to aspects of MS care was common, according to study results published in Multiple Sclerosis and Related Disorders.

While patients with MS are at a low risk for severe COVID-19 infection, concern and fear of infection may impact patients’ adherence to care through avoidance of medical facilities and healthcare workers during the pandemic.

The objective of the current study was to determine the degree of concern in patients with MS during the COVID-19 pandemic and the adherence to care using a survey emailed to patients from a large MS center in New York City.

Of 3153 survey invitation emails sent, 596 patients (78.9% women) responded to the survey during 2 weeks in April 2020, including 472 patients with MS, 13 patients with neuromyelitis optica, 7 patients with clinically isolated syndrome and 30 patients with other diagnoses. Only 35 patients (6.7%) were tested for COVID-19 at the time of the survey, of whom 14 (40%) tested positive.

There was a high degree of concern among patients with MS for COVID-19 infection during the local height of the pandemic, as most patients reported they strongly agree (54.1%) or agree (34.0%) with the statement “I am or was concerned about becoming infected with COVID-19”. Similarly, most patients were concerned about MS increasing risk of COVID-19 infection (38.6% strongly agreed; 31.3% agreed) and were concerned about disease modifying therapies increasing risk for COVID-19 infection (36.5% strongly agreed; 31.0% agreed).

Patients frequently postponed appointments (41%), a decision usually made by the patient (27.9%), and rarely by the provider (12.9%). In addition, patients postponed laboratory studies (46%), and magnetic resonance imaging (MRI) studies (41%). However, treatment with disease modifying therapies was rarely postponed (12.5%).

Degree of concern for COVID-19 infection was associated with postponing appointments (P =.020) and laboratory studies (P =.016), but not with adherence to MRIs and disease modifying therapies.

The study had several limitations, including using data from a single center, potential impact of the timing of the study in relation to the pandemic, potential selection and recall bias, and low response rate to the survey.

“The study results show a high degree of concern among MS patients for COVID-19 infection during the local peak of the pandemic. Deviations to recommended routines for MS care occurred through frequent postponing of appointments, laboratory studies, and MRIs. Nevertheless, noncompliance with DMTs was rare,” concluded the study researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Zhang Y, Staker E, Cutter G, Krieger S, Miller AE. Perceptions of risk and adherence to care in MS patients during the COVID-19 pandemic: a cross-sectional study. Mult Scler Relat Disord. Published online February 22, 2021. doi:10.1016/j.msard.2021.102856