Observational Study of Repeat Immunoadsorption in Post-COVID ME/CFS Patients with Elevated Beta-2-Adrenergic Autoantibodies

[Dude]

Abstract​

There is increasing evidence for an autoimmune aetiology in post-infectious Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). SARS-CoV-2 has now become the main trigger for ME/CFS. We have already conducted two small proof-of-concept studies of IgG depletion by immunoadsorption (IA) in post-infectious ME/CFS, which showed efficacy in most patients. This observational study aims to evaluate the efficacy of IA in patients with post-COVID-19 ME/CFS. The primary objective is to assess the improvement in functional ability. Due to the urgency of finding therapies for post-Covid-Syndrome (PCS), we report here the interim results of the first ten patients with seven responders defined by an increase of between 10 and 35 points in the Short-Form 36 Physical Function (SF36-PF) at week four after IA. The results of this observational study will provide the basis for patient selection for a randomised controlled trial (RTC) including sham apheresis and for a RTC combining IA with B-cell depletion therapy.

https://www.medrxiv.org/content/10.1101/2023.08.31.23294813v1

 

[Dude]

This also might be interesting:

The results of this observational study will provide the basis for a randomized controlled clinical trial (RCT) combining IA with B-cell depletion therapy preferentially with Obinutuzumab.

As far as i understand obinutuzumab is a better version of Rituximab.

Chat GPT: Brief comparison between Rituximab and Obinutuzumab:

1. **Mechanism of Action:**
- **Rituximab:** It is a monoclonal antibody that targets CD20 on B cells, leading to their destruction by the immune system.
- **Obinutuzumab:** This monoclonal antibody also targets CD20 but works differently by engaging the immune system more effectively, resulting in increased B cell depletion.

2. **Indications:**
- **Rituximab:** Commonly used to treat various B cell-related malignancies, such as non-Hodgkin lymphoma and chronic lymphocytic leukemia. It's also used for certain autoimmune disorders.
- **Obinutuzumab:** Primarily used for the treatment of chronic lymphocytic leukemia and follicular lymphoma.

3. **Efficacy:**
- **Rituximab:** Established efficacy with years of clinical use and data.
- **Obinutuzumab:** Developed to potentially have improved efficacy over Rituximab, especially in certain types of lymphomas.

4. **Administration:**
- **Rituximab:** Typically administered intravenously.
- **Obinutuzumab:** Also administered intravenously but often requires a longer infusion time.

5. **Side Effects:**
- **Rituximab:** Common side effects include infusion reactions, fever, and fatigue.
- **Obinutuzumab:** May cause more infusion-related reactions compared to Rituximab, but these can be managed with pre-medication.

6. **Cost:**
- **Rituximab:** May be more cost-effective due to its longer presence in the market and availability as a biosimilar.
- **Obinutuzumab:** Tends to be more expensive, particularly as it may not have as many generic alternatives.

7. **Clinical Considerations:**
- The choice between Rituximab and Obinutuzumab depends on the specific disease being treated, the patient's overall health, and the clinical recommendations of the treating physician.

 

[Forummember9922]

(From link)
We previously conducted a first observational study to investigate the effect of immunoadsorption (IA) in patients with infection- triggered ME/CFS with elevated ADRB2 AABs. We observed a rapid improvement of symptoms with both short and long-term responses in seven of ten patients [10, 11].

I wonder if muscarinic and beta adrenergic dysfunction has been too quickly cast away as old news and therefore thought of as fruitless when that dysfunction could be more of an upstream event.

Many tolerate beta blockers but I also know someone with CFS who swears by pseudoephedrine, a beta agonist. But for many that would be a terrible /dangerous drug to try. I intend to experiment in the near future with extremely tiny doses of pseudoephedrine.