Remission of severe forms of Long Covid following monoclonal antibody (MCA) infusions: A report of signal index cases..., 2024, Scheppke, Klimas et al

Note: title change in final publication - see post below

Preprint
Pathophysiology and potential treatment of long COVID: A report of signal index cases and call for targeted research, 2023, Scheppke, Klimas et al

Objective
Long COVID has afflicted tens of millions globally leaving many previously-healthy persons severely and indefinitely debilitated. The objective here was to report cases of complete, rapid remission of severe forms of long COVID following certain monoclonal antibody (MCA) infusions and review the corresponding pathophysiological implications.

Design
Case histories of the first three index events (among others) are presented. Unaware of others with similar remissions, each subject independently completed personal narratives and standardized surveys regarding demographics/occupation, past history, and the presence and respective severity grading of 33 signs/symptoms associated with long COVID, comparing the presence/severity of those symptoms during the pre-COVID, long-COVID, post-vaccination, and post-MCA phases.

Setting
Patient interviews, e-mails and telephone conversations.

Subjects
Three previously healthy, middle-aged, highly-functioning persons, two women and one man (ages 60, 43, and 63 years respectively) who, post-acute COVID-19 infection, developed chronic, unrelenting fatigue and cognitive impairment along with other severe, disabling symptoms. Each then independently reported incidental and unanticipated complete remissions within days of MCA treatment.

Interventions
The casirivimab/imdevimab cocktail.

Measurements and main results
Irrespective of sex, age, vaccination status, or illness duration (18, 8 and 5 months, respectively), each subject experienced the same complete remission of their persistent disabling disease within a week of MCA infusion. Each rapidly returned to normal health and previous lifestyles/occupations with normalized exercise tolerance, still sustained to date nearly two years later.

Conclusions
These index cases provide compelling clinical signals that MCA infusions may be capable of treating long COVID in certain cases, including those with severe debilitation. While the complete and sustained remissions observed here may only apply to long COVID resulting from pre-Delta variants and the specific MCA infused, the striking rapid and complete remissions observed in these cases also provide mechanistic implications for treating/managing other post-viral chronic conditions and long COVID from other variants.

Key points

• Question: Considering that long COVID-19 has been devastating for many millions worldwide, what is the proposed pathophysiology and are there any effective treatments?
  
  
• Findings: Previously-healthy middle-aged persons who had developed persistent debilitating post-acute SARS-CoV-2 sequelae, each experienced complete remission their symptoms within days of receiving a specific monoclonal anti-body infusion despite relative differences in sex, age, vaccination status, and long COVID duration.
  
  
• Meaning: Certain monoclonal antibody infusions may be capable of reversing severe long COVID. Beyond providing an effective potential treatment for long COVID, these findings have mechanistic implications for treating other post-viral chronic conditions, including future long COVID variants.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S073567572300534X

 

Long Covid
Long Bio
TLDR

https://useagles.org/teammembers/paul-e-pepe/

 

Probably because of funding. I’m fine with them publishing a case study. Now they have something that they can cite for developing a larger proposal.

 

Indeed the monoclonal antibodies were adminstered in October and September 2021. The price of the drug doesn't seem to be too high either (at least compared to some other things) at roughly $1000 per person, from what I calculated. One would think they would have tried this on more patients by now given the phenomenal results they achieved 2 years ago. They do mention though that these 3 patients received the drug on the basis of a very recent Covid-19 reinfection (there are also some anecdotal stories where a reinfection seemed to cure Long Covid) rather than being Long Covid related.

The journal pre-proof mentions "Among other cases being followed by the investigators, MCA infusions did not improve long COVID patients with isolated (but persistent) anosmia/dysgeusia.", but I don't have access to the paper either.

 

This is a pretty weird statement. It seems that the 'objective' was to report the ones that did brilliantly, with no mention of anyone who didn't.

This is not how you do preliminary or pilot studies. Been there, done that.

 

Noting: "We also express our sincere gratefulness to those various members of the Centers for Disease Control and Prevention (CDC) who provided the investigators with tremendous guidance regarding these findings in the early phases of the project."

This is a summary case series. The summary seems to be that 3 patients with established LC received Regen-Cov2 (casirivimab/imdevimab) as an anti-spike monoclonal-antibody "cocktail" due to repeat (or significant exposure to) acute Covid that was thought to significantly risk worsening of their symptoms.

 

The case reports all read very similarly and I've summarised below. Note case 2 did not re-enter LC despite repeat infection post recovery. If nothing else, this at least confirms that:
1. It is possible to recover completely
2. Any effect of deconditioning is rapidly reversed on resuming normal life and exercise

And suggests that:
There may be a stochastic effect - even with a documented predisposition to LC, repeat infection does not mandate return to pathological state (variant viral infections being noted of course)

 

Not that I can see.

I read that as "recovered".

Edit: correct my last word.

 

From Appendix B (original emphasis) —

 

Also from supplementary materials: Appendix B —

 

None, as far as I can tell. All cases read as having been self-driven return to prior activity and normal life, without any need for rehabilitation (as would seem to have been consistently reported for decades by ME patients who have recovered.)