Efficacy of Repeat Immunoadsorption in Post-COVID ME/CFS Patients with Elevated B2-Adrenergic Receptor Autoantibodies - 2024, Stein, Scheibenbogen

Preprint
Link to published paper here
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The Lancet: Efficacy of Repeat Immunoadsorption in Post-COVID ME/CFS Patients with Elevated B2-Adrenergic Receptor Autoantibodies: A Prospective Cohort Study

Abstract
Background: Since the pandemic, SARS-CoV-2 has become the leading trigger for ME/CFS. Evidence indicates autoimmunity plays an important pathophysiological role.

Methods: This prospective cohort study included 20 post-COVID ME/CFS patients found to have elevated β2 AR-AB between October 2022 and October 2023. They received five immunoadsorption sessions at the Charité Universitätsmedizin Berlin, Germany. Response was defined as ≥ ten-point increase in the SF-36 PF four weeks post immunoadsorption. Key symptoms were assessed via questionnaires over six months. Handgrip strength and EndoPAT measurements were used to evaluate muscle fatigue and vascular dysfunction. Seven out of 14 patients who worsened after initial response received a second cycle.

Findings: The treatment was generally well tolerated, reducing total IgG by 79·15 % (IQR: 75·47 – 83·19%) and β2 AR-AB by 78·14 % (IQR: 67·06 – 86·18%). 14 out of 20 patients responded to the treatment with an increase in the median SF-36 PF score from 25 to 60. Improvements were reported in fatigue (p = 0·028), post-exertional malaise (p = 0·005), pain (p = 0·007), cognitive (p = 0·010), autonomic (p = 0·004), and immunological (p = 0·001) symptoms. Female patients had increased handgrip strength (p = 0·036). In most patients symptoms worsened again after six months.

Interpretation: Immunoadsorption can temporarily improve symptoms in post-COVID ME/CFS patients. The beneficial effects of IgG depletion suggest a significant role for autoantibodies and disturbed B-cell function in the condition’s pathophysiology.


https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4911576

 

Scheibenbogen on Twitter:

Our Charité study on immunoadsorption in post-COVID MECFS as a preprint in Lancet: 14 out of 20 improved, but mostly not long-lasting. We are preparing studies on the combination of immunoadsorption with B cell depletion.

 

it's not the sort of ultra cure you might hope for when matching a treatment to a defined subset. And with people whose course of illness is short, you'd expect some spontaneous remissions. Definitely ambiguous to me whether they have something there.

 

Thanks for all the great analysis (as usual).

And yes, I think the Rituximab open label study showed at least as big an effect, while the blinded follow-up showed none.

This study is similarly unblinded with no control, only this time with very short duration where significant improvement might be expected. A full blinded, controlled study would be interesting.

 

I'm endlessly frustrated by studies like these! Is the idea just to get funding for a double-blind study

Because it would be really valuble to know if this stuff actually worked.

 

Or is it to make money selling their treatment to desperate people.

 

Note that this study didn’t have a control group and therefore had no bliding. And most of the participants had only been sick 1-3 years (median 22 months) which is a timeframe which often coincides with natural improvements.

Also, if later on we do learn that this treatment does in fact work, I would guess it’s possible it only works in the early stage of the disease before the condition becomes “permanent”.

 

ME Research UK:

Researchers at Charité University Hospital in Berlin highlighted evidence that autoantibodies may be involved in the pathophysiology (underlying disease processes) of long COVID and ME/CFS. To test the hypothesis, they recruited 20 individuals with long COVID, who met the Canadian Consensus Criteria for ME/CFS, for immunoadsorption treatment to remove certain autoantibodies. The majority of patients experienced a clinical improvement in symptoms at six months.

The team is currently conducting randomised controlled trials with larger sample sizes to better assess the effectiveness of immunoadsorption in post-COVID ME/CFS.

Read more: https://bit.ly/3DJIcGp