Background

Infection-triggered disease onset, chronic immune activation and autonomic dysregulation in CFS point to an autoimmune disease directed against neurotransmitter receptors. Autoantibodies (Aab) against G-protein coupled receptors were shown to play a pathogenic role in several autoimmune diseases.

Therapeutic approaches can be based on the principle of reduction of agonistic Aab. These principles could therefore lead to an improvement in the quality of life of Long Covid patients.

Methods

All eligible Patients with long COVID (n=) and ME/CFS (n=) received IA (primary device: Spectra Optia, Terumo BCT, Inc. Lakewood, USA/TPE; secondary device: ADAsorb medicap clinic, Ulrichstein, Germany TheraSorb Ig omni 5 Adsorber Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany). Patients received 5 treatments on 5 consecutive days. The 2.0-fold individual total plasma volume was processed on days 1–5. Blood was drawn immediately before and after the IA session from an antecubital vein. Patients were followed up directly after last apheresis. The primary endpoint was to remove the autoantibodies and to lower plasma IgG to levels below 2 g/l after the last treatment.

Results

Between January and December 2022, 99 patients (w=54, m=45), were screened for eligibility, most of them between 30 and 50 years old (< 30 (n=25), 30-39 (n=30), 40-49 (n=24), 50–70 (n=20)).The removal of IgG was successfully high (IgG lowering about 90 %). The symptom descriptions of the patients before and after IA suggest that solely using the evaluation of the Bell score does not reliably reflect the predominantly positive development after IA treatment, since patients have other main problems beside exhaustion! Our specially developed questionnaire shows improvement for most of the treated patients; e.g: How have your symptoms changed since your treatment at the DHZ? -> About 71% improved, 15,5% unchanged, about 14% deteriorated.

Conclusion

IA is a safe and efficient method for the removal of (auto-)antibodies. A clinical benefit could be demonstrated in most of the patients, but larger trials are needed. Ideally, the free and bound Aab are measured after treatment (antibody screening/biopsy). Maintenance therapy could be a further indication to prevent relapses caused by trigger factors (e.g. infection, vaccination, stress). The treatment decision of the involved physician should be used for a follow-up treatment after IA.

Offenlegung Interessenkonflikt:

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