A Single-Center Pilot Study of Therapeutic Apheresis in Patients with Severe Post-COVID Syndrome.
Korth, Johannes, Steenblock, Charlotte, Walther, Romy et al. · Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme · 2024 · DOI
Quick Summary
This small study looked at whether a blood-filtering treatment called apheresis could help 20 people with long COVID symptoms similar to ME/CFS. The researchers found that the treatment reduced harmful antibodies in patients' blood and many patients reported feeling better, with less fatigue, muscle pain, and post-exertional malaise. While these results are promising, the study was small and didn't use a control group, so we need larger tests to confirm whether the treatment truly works.
Why It Matters
This study provides preliminary evidence supporting an autoimmune mechanism in post-COVID/ME/CFS pathology and explores a potential mechanism-based treatment strategy. For patients experiencing severe, disabling post-COVID symptoms, this represents an early-stage exploration of apheresis as a possible therapeutic option, particularly relevant given the lack of approved disease-modifying treatments for ME/CFS.
Observed Findings
All 20 patients showed decline in β1 or β2 adrenergic receptor antibodies after apheresis treatment.
The majority of treated patients reported concurrent reductions in fatigue, physical activity restrictions, myalgia, post-exertional malaise, and concentration disorders.
Apheresis appears to temporarily improve microperfusion and associated symptoms in post-COVID patients.
Several patients reportedly returned to work and normal life activities following treatment.
Inferred Conclusions
Agonistic autoantibodies targeting adrenergic and muscarinic receptors may play a pathogenic role in post-COVID syndrome and ME/CFS.
Therapeutic apheresis may benefit post-COVID patients even if future sham-controlled trials are negative, through mechanisms including antibody removal and microperfusion improvement.
Extracorporeal apheresis warrants consideration as an early intervention component in multimodal treatment of postinfectious syndromes in selected patients.
Remaining Questions
Would apheresis demonstrate clinical efficacy in a randomized, sham-controlled trial design?
What is the durability of clinical benefits after apheresis, and do symptoms recur as antibodies reaccumulate?
Can biomarkers (such as specific autoantibody profiles) predict which patients will respond best to apheresis treatment?
What This Study Does Not Prove
This pilot study does not prove that apheresis is effective, as it lacked a placebo control group and relied on patient-reported outcomes susceptible to expectancy effects. The study demonstrates correlation between antibody reduction and symptom improvement but cannot establish that antibody removal caused the clinical benefits. Findings cannot be generalized beyond the specific patient population studied, and longer-term efficacy and safety remain unestablished.