Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study. — CFSMEATLAS
Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study.
Stein, Elisa, Heindrich, Cornelia, Wittke, Kirsten et al. · The Lancet regional health. Europe · 2025 · DOI
Quick Summary
This study tested a blood-filtering treatment called immunoadsorption in 20 patients with post-COVID ME/CFS who had specific autoantibodies (immune proteins attacking their own bodies). After five treatment sessions, 70% of patients improved, with better physical function, reduced fatigue, and less post-exertional malaise lasting at least six months. The treatment removed harmful immune proteins from the blood and was generally well tolerated.
Why It Matters
This is the first study demonstrating that removing specific autoimmune antibodies can produce sustained symptom improvement in post-COVID ME/CFS patients, providing evidence for an autoimmune mechanism in the disease. If validated in larger trials, immunoadsorption could become a targeted treatment option for the subset of ME/CFS patients with elevated β2-adrenergic receptor autoantibodies. The findings support the hypothesis that B-cell dysfunction and autoimmunity contribute significantly to post-COVID ME/CFS pathophysiology.
Observed Findings
70% of patients (14/20) were responders, achieving ≥10-point improvement in SF-36 physical functioning
Immunoadsorption reduced total IgG by 79% and β2-adrenergic receptor autoantibodies by 77%
Mean SF-36 physical functioning improved by 17.75 points, with peak improvements at months 2-3
Improvements in fatigue, post-exertional malaise, pain, cognitive symptoms, and autonomic symptoms were maintained through month 6
Female patients showed increased repeat handgrip strength at month 6; 7 patients received a second treatment cycle after initial worsening
Inferred Conclusions
Immunoadsorption may be effective for post-COVID ME/CFS patients with elevated β2-adrenergic receptor autoantibodies
Autoantibodies and disturbed B-cell function play a significant pathophysiological role in post-COVID ME/CFS
IgG depletion leads to sustained symptom improvement, suggesting autoimmunity is a targetable mechanism in this patient subset
Remaining Questions
Does immunoadsorption benefit ME/CFS patients without elevated β2 AR-AB or with other autoantibody profiles?
How long do treatment benefits persist beyond six months, and do patients require maintenance therapy?
What This Study Does Not Prove
This study does not prove immunoadsorption works for all ME/CFS patients, only those with elevated β2 AR-AB, and the lack of a control group means improvements cannot definitively be attributed to the treatment rather than natural recovery or placebo effect. The small sample size (n=20) limits generalizability, and longer-term durability beyond six months remains unknown. Causation between β2 AR-AB and symptoms is inferred but not definitively established.