In the blog category “From our community”, we address treatments that are being discussed controversially by people affected by Long COVID and health care professionals. In the Altea forum, in stories, and in discussions with those affected, we have seen a number of treatment suggestions that are not officially recommended (yet). To help judge the safety and effectiveness of these treatments, we are exploring the science behind them. We are aiming to provide an overview of the available evidence, evaluate whether or not the available data is reliable, and summarize which risks might be associated with these treatments. Today, we want to assess Apheresis.
Apheresis, sometimes also called “blood washing”, is an expensive, invasive medical procedure that separates one or more specific components from a patient's blood and returns the remaining blood to the patient. It was initially developed for the treatment of patients with very high levels of “bad” cholesterol who did not respond to other therapies. Apheresis also has other beneficial effects, such as the removal of inflammatory molecules (cytokines), autoantibodies and compounds that thicken the blood. Because these factors might play a role in Long COVID (as shown in a previous blog), an idea has emerged that apheresis could be used to treat Long COVID.
Overview of the procedure
No correlation between autoantibodies and Long COVID fatigue
A recent study investigated whether reducing levels of autoantibodies, lipids, blood-thickening (coagulation) factors, and inflammatory cytokines improves symptoms in patients with Long COVID. A total of 27 patients (14 men and 13 women) from clinics in Germany and Switzerland who experienced fatigue from Long COVID underwent INUSpheresis, which is a form of therapeutic apheresis that removes these molecules from the blood. Patients´ blood was collected before and after the procedure to measure these biomarkers.
In the 27 patients, who all reported an improvement after two cycles of apheresis, the researchers observed considerably lower levels of all selected autoantibodies, markers of inflammation, coagulation factors, lipids, and hydrogen peroxide (a marker of oxidative stress). These results are expected, as apheresis is a technology known to successfully remove these molecules from the blood. Strikingly, the study included only patients who experienced improvements; no comparison to a control group or patients who still had symptoms after apheresis, is available.
First part of the study: Improvement through INUSpheresis
A further analysis of 123 patients with fatigue symptoms explored whether fatigue is actually associated with higher levels of four specific antibodies. The study failed to show a correlation between the severity of fatigue and elevated antibodies in this group of patients. This means that some patients with very high antibody levels only had mild symptoms, while others with normal antibody levels were very ill.
It is important to underline that this study was not conducted as a randomized controlled trial, which is a modern scientific method to rigorously evaluate the effectiveness and safety of treatments (as explained on Altea). Although the study authors argue that such trials are ethically challenging and time-consuming for invasive procedures (for example, apheresis), well-designed clinical studies are currently the gold standard for producing high-quality evidence. Anecdotal reports and personal experience are unreliable forms of proof, especially when the exact mechanisms of treatment are not fully understood.
Second part of the study: Correlation between antibody levels and symptoms.
Apheresis is an unproven treatment for Long COVID
In another article published about a year ago, the head of one of the clinics in Germany offering this treatment and her colleagues argue that Long COVID patients could theoretically benefit from heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.) apheresis. This is a type of apheresis that decreases lipoproteins, fibrinogen (a coagulation factor), inflammatory molecules and some other compounds involved in the progression of atherosclerosis (fatty deposits in arteries). Being in clinical use for 38 years, the therapy has been applied to a spectrum of diseases and can be used safely in combination with several drugs.
Based on this data, the authors contend that H.E.L.P. apheresis has the potential to remove SARS-CoV-2 spike protein, as well as substantial amounts of fibrinogen, inflammatory cytokines and autoantibodies also in patients with Long COVID. They, however, provide no results from a well-designed clinical study to support this claim, except for their anecdotal experience with Long COVID patients in clinical practice.
Apheresis is generally safe
Therapeutic apheresis has been used for many decades and is considered safe; however, it is an invasive procedure and complications may occur, although rare. Patients can experience side effects such as nausea, tiredness, vomiting, chest pain and low blood pressure. In addition, the use of anticoagulants (a substance that prevents the blood from clotting during the procedure) can increase the risk of bleeding, including brain hemorrhage, and should be given under clinical supervision only. Patients should also be followed up for a while after apheresis.
Another challenge for patients with fatigue and limited energy is that each apheresis treatment lasts at least two hours. The therapy is also very expensive and can cost several thousand Swiss francs per session, which is not covered by health insurers. This is because, due to a lack of evidence from clinical trials, apheresis is not approved for the treatment of Long COVID by the regulatory agencies.
As apheresis can have serious side effects and places a financial burden on someone who might already be struggling due to a reduced ability to work, it should be a well thought-out decision. We recommend thorough planning with health care professionals and suggest seeking a second opinion before committing to the procedure.
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