Fatigue, Post-Acute COVID-19 Syndrome
Conditions
Keywords
Post COVID syndrome, Fatigue, Immunoadsorption
Brief summary
The complex clinical symptoms of post COVID syndrome, especially chronic fatigue, pose a major challenge to patients and to the health care system and are frequently refractory to therapeutic intervention. There is increasing evidence that a dysregulated post-viral immune response may be involved in the pathogenesis of post COVID syndrome. In uncontrolled case studies, an improvement of fatigue symptoms after removing autoantibodies has been reported in post COVID patients. However, there is a lack of prospective, sham controlled studies. We initiate an interventional, randomised, sham treatment-controlled prospective study, the EXTINCT post COVID study, which aims to scientifically test the therapeutic efficacy of an extracorporeal apheresis procedure (immunoadsorption) for the treatment of a well characterized cohort of patients with post COVID syndrome, while at the same time providing basic research evidence for an understanding of the pathogenesis of post COVID syndrome. Thereby, we expect to obtain important insights into the diagnosis, treatment and pathophysiology of post-COVID syndrome.
Interventions
PROCEDUREImmunoadsorption vs. sham immunoadsorption
5 treatments within 14 days
Sponsors
Hannover Medical School
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Masking description
double-blind
Intervention model description
Double-blinded, randomized, sham-controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-75 years 2. Chronic Fatigue Syndrome (CFS) according to Canadian Consensus Criteria (at two time points \> 4 weeks apart) with a duration of \> 6 months with new onset \< 12 weeks after PCR test confirmed SARS-CoV2-infection 3. Chalder Fatigue Scale \>/= 4 binary scale (at two time points \> 4 weeks apart) 4. Post exertional malaise \>/= 14 h (at two time points \> 4 weeks apart) 5. Bell Scale 20-50 (at two time points \> 4 weeks apart) 6. Willing to comply with all aspects of the protocol, including blood draws, magnetic resonance imaging and ophthalmological evaluation 7. Patient is able to understand and fully participate in the activities of the study and consent in accordance with guidelines 8. Female patients of childbearing potential who are sexually active must be willing to use an acceptable form of contraception. Female patients must not be pregnant, planning to become pregnant, or be actively breastfeeding through the entire period. Exclusion citeria: 1. Chronic fatigue due to other medical or psychological condition 2. Preexisting chronic fatigue prior to COVID infection 3. Oxygen requirement or ventilation during acute phase of COVID 4. Positive SARS-CoV-2-PCR test at the beginning of the study 5. Comorbidity bearing risk that patient might not tolerate treatment as judged by investigator including among others: malignant disease within the last 5 years, moderate to severe renal impairment (eGFR \<60 ml/min), cardiac insufficiency (LVEF \<40%), severe coronary heart disease, severe hypercoagulability 6. Acute or severe psychiatric disease 7. Active/acute infectious diseases like CMV, EBV, HBV, HCV, HIV, TBC 8. Patients who in the investigator's opinion might not be suitable for study (difficult peripheral venous access, not able to complete questionnaires e.g. due to language problems) 9. Taking immunosuppressive medication \>3 weeks within 12 months before study inclusion 10. Any apheresis therapy before study inclusion 11. Contraindications for magnetic resonance imaging 12. Patients revealing abnormal brain structures visible in MR images 13. Patients with pre-existing ophthalmological condition or diabetes mellitus
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chalder Fatigue Scale | 12 weeks | Time course of fatigue symptoms as determined based on Chalder Fatigue Scale (ranging from 0 to 33), higher values indicating a higher burden of fatigue symptoms |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cognitive Function | 12 weeks | Assessment of cognitive function measured by Montreal Cognitive Assessment (Scale 0-30), lower values indicating cognitive impairment |
| Post exertional malaise symptoms | 12 weeks | Assessment of frequency and severity of post exertional malaise symptoms (frequency: 0-20, severity: 0-20, duration), higher values indicating a higher burden of post exertional malaise symptoms |
| Measure of health status | 12 weeks | Evaluation of health status by Short Form Health Survey (SF-36) |
| Depression and Anxiety | 12 weeks | Symptoms of depression and anxiety measured by Hospital Anxiety and Depression Scale (HADS) |
| Optical coherence tomography angiography | 12 weeks | Assessment of retinal microcirculation |
| 6-min. walk test | 12 weeks | Walking distance, oxygen saturation, heart rate and dyspnea assessed during 6-min. walk test |
| Hand grip strength | 12 weeks | Hand grip strength measured via digital hand dynamometer |
| Cranial magnetic resonance imaging and spectroscopy | 12 weeks | Cranial magnetic resonance imaging and assessment of region-dependent metabolic distributions |
| Symptoms related to chronic fatigue before and after immunoadsorption | 12 weeks | Change of symptoms as measured by Fluge score, using a scale ranging from 1 to 10 (higher values representing higher symptom load) assessing 32 fatigue related symptoms and their intra-patient change from baseline to follow-up |
| Neurocognitive function | 12 weeks | Attentional deficits as assessed by Test of Attentional Performance |
| Autonomic dysfunction | 12 weeks | Symptoms of autonomic dysfunction assessed by Composite Autonomic Symptom Score (COMPASS 31), generating a weighted score from 0 to 100, with higher scores representing higher symptom burden |
Other
| Measure | Time frame | Description |
|---|---|---|
| Safety and tolerability of immunoadsorption treatment | 12 weeks | Number of treatment emergent adverse events, serious adverse events and discontinuation due to treatment emergent adverse events |
Countries
Germany
Outcome results
None listed