Evidence mapPaperPMID 40510870Full record

ArticleNeurology. Clinical practice2025

Infection, Relapses, and Pseudo-Relapses in Individuals With Multiple Sclerosis.

Amber Salter, Samantha Lancia, Mudita Sharma, Gary R Cutter, Robert J Fox, Ruth Ann Marrie

Registry-linked trialAbstract read
In one paragraph

Article in Neurology. Clinical practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01018537 (NARCOMS Global Multiple Sclerosis Registry), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01018537 recruitingnot on this map

NARCOMS Global Multiple Sclerosis Registry: A Long-Term Study to Facilitate Research in Multiple Sclerosis

Typeobservational_patient_registrySponsorUniversity of Texas Southwestern Medical CenterRan1996 to 2050Enrolled50,000ConditionsMultiple Sclerosis
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Amber SalterDepartment of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas.ORCID https://orcid.org/0000-0002-1088-110X
Samantha LanciaDepartment of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas.ORCID https://orcid.org/0000-0001-8871-7134
Mudita SharmaDepartment of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern, Dallas.ORCID https://orcid.org/0009-0004-8171-8221
Gary R CutterDepartment of Biostatistics, University of Alabama in Birmingham.ORCID https://orcid.org/0000-0002-8455-980X
Robert J FoxMellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Ohio.ORCID https://orcid.org/0000-0002-4263-3717
Ruth Ann MarrieDepartment of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Canada; and.ORCID https://orcid.org/0000-0002-1855-5595

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and Objectives: Infections are associated with an increased risk of relapse and pseudo-relapse in persons with multiple sclerosis (MS). However, the relationship with relapses and pseudo-relapses after SARS-CoV-2 infections (COVID) vs other infections in MS is poorly understood. Therefore, we compared the occurrence of relapse and pseudo-relapse after COVID and other infections with noninfected participants with MS. Methods: In spring 2023, we surveyed participants from the North American Research Committee on Multiple Sclerosis Registry regarding whether they had had a COVID infection, other infections, relapses, and pseudo-relapses. Recent infections, occurring in the 6 months before the survey, were used to categorize participants into groups: recent COVID, non-COVID infection (with no history of ever having COVID), COVID and non-COVID infections, or uninfected. Results: Of the 4,787 participants eligible for analysis, 2,927 participants were included, of whom 294 (10%) had a recent COVID infection; 853 (29.1%) had 1 recent infection other than COVID; 246 (8.4%) had a recent COVID and non-COVID infection; and 1,534 (52.4%) had no infection with COVID nor any infection within the past 6 months (uninfected). Compared with no infections, non-COVID infection was associated with a 39% increased likelihood of relapse (1.39, 95% CI [1.04-1.87]), whereas a recent COVID infection was associated with a decreased likelihood of relapse (0.45 [0.23, 0.87]), adjusting for covariates. All infection groups were associated with increased odds of pseudo-relapse compared with the uninfected group (non-COVID infections: 1.78 [1.44, 2.20]; COVID infection: 1.80 [1.32, 2.45]; COVID and non-COVID infection: 3.04 [2.24, 4.12]). Discussion: Because individuals with MS are at increased risk of infections, the association of infections with relapses and pseudo-relapses is clinically important. The high prevalence of acute worsening after infection, regardless of the type of infection, compared with those with no reported infection, needs to be considered in the management of persons with MS.

Identifiers

PMID40510870
PMCPMC12153504

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.