Post-COVID conditions (PCC)/long COVID and chronic fatigue syndrome (CFS): Practical experience in the treatment with immunoadsoption (IA) and plasma exchange (PE)

ABSTRACT

Background: Many people have been infected by SARS-CoV-2 virus. A vast number of individuals complain about continuing breathlessness and fatigue even months after the onset of the disease. This overwhelming phenomenon has been called "post-COVID syndrome" or "long-COVID". There are striking similarities to myalgic encephalomyelitis (ME) / CFS linked to a viral and autoimmune pathogenesis. In both disorders neurotransmitter receptor antibodies against s-adrenergic and muscarinic receptors may play a key role. Method(s) We found similar elevation of these AAB in both patient groups. Eligible patients with PCC and CFS have receive IA or PE. Patients in both groups received 5 treatments on 5 days. In the IA group, the 2-fold individual total plasma vol (TPV) was processed on each day. In the PE group, 2.5 L of plasma (corresponding to the 1-fold individual TPV) were removed each day and substituted by 5% human albumin solution. The primary endpoint was the removal of AAB. Side effects like hypotension, citrate reaction occured but did not lead to cessation of the session. Due to only minimal loss of both IgA and IgM there is no need to isolate patients during the couse of IA. Also 20-30% of IgG remains available to protect the patients against infections. Result(s) Between January 10, 2022, and March 31, 2022, 26 patients (w =11, m = 15), were screened for eligibility, most of them between 20 and 50 years old (24 = 20-50 y, 2 = >50). 26 patients have received 132 treatments with IA (n = 24) or PE (n = 2). Blood was drawn immediately before and after the apheresis sessions. Results showed lowered values for IgG 72.10% (average pre 4.47 g/l vs. post 1.24 g/l), IgM 30.16% (pre 0.930 g/l vs. post 0.684 g/l), IgA 27.95% (pre 1.38 g/l vs. post 1.05) and Fibrinogen 38.21% (pre 1.683 g/l vs. post 1.045 g/l). Treatment resulted in lowering of plasma IgG to levels below 2 g/l. 20 patients reported a subjective improvement after the treatment. Conclusion(s) Aggressive immunoglobulin elimination with appropriate IA or PE can be beneficial in cases of PCC/CFS. IA and PE seem to be effective and safe in reducing pathogenic antibodies in a significant way clearly improving the debilitating symptoms of patients with long COVID/CFS. Therefore, IA and PE may provide a promising therapeutic option for patients with PCC. This method will also be effective when other hitherto unknown antibodies and inflammatory mediators are involved. (Figure Presented).