DOI: 10.12688/f1000research.186744.1 ISSN: 2046-1402

Feasibility and outcomes of crossflow membrane plasmapheresis for long COVID in Suriname: a randomized double-blind placebo-controlled pilot trial

Rosita Bihariesingh-Sanchit, Rakesh Bansie, Prija Paltoe, Rocade Ma, Debra Bustamente, Dhiradj Ramesar, Radha Raghosing-Sanchit, John Codrington, Inhya Ma-Bihariesingh, Stephen Vreden, Fey van der Dijs, Rishi Mangroo, Monique Simson, Navin Ramdhani, Cesar Fung A Foek, Angélique van 't Wout, Dimitri Diavatopoulos, Marien de Jonge, Arno Nierich
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Background Long COVID is heterogeneous and currently without cure. The disease resembles myalgic encephalomyelitis/chronic fatigue syndrome, which is driven by autoantibodies, leading to exploration of therapeutic plasma exchange (TPE) to reduce autoantibody levels as a potential treatment option. Methods We conducted a randomized, double-blind, placebo-controlled clinical trial comparing TPE with placebo treatment in a resource-limited setting in Suriname. Participants were adults aged 18 to 65 years with physician-confirmed long COVID and questionnaire-defined functional impairment. Treatment consisted of 5 TPE or placebo treatment (blood draw followed by whole blood reinfusion) sessions each separated by two days. Clinical outcomes were assessed using three different fatigue scores at baseline, day 28 and day 90. Results Of 189 patients assessed for eligibility, 18 were randomized and analyzed (mean age [SD], 46 years; 11 females [61%]; mean baseline Chalder fatigue score, 21). While Chalder fatigue scores at 90 days were significantly improved over baseline in the TPE group (mean [SD] at baseline: 20, 90 days: 10, P = 0.0003) and not in the placebo group (baseline: 22, 90 days: 12, P = 0.0628), between both groups the scores were not statistically significantly different at 90 days ( P = 0.8770). There was also no significant difference in the percentage of patients that achieved >30% Chalder fatigue score improvement (9 of 11 TPE-treated patients (81.8%) versus 5 of 7 placebo-treated patients (71.4%); difference 10.4% [95% CI, -33.4% to 51.8%]; P  > .9999). Results were consistent among the three different fatigue scores used. No serious treatment-emergent adverse events were reported in either group. Conclusions Our study found reductions in fatigue in both the TPE- and placebo-treatment groups. Larger randomized trials with biomarker-guided patient selection may be required to demonstrate a beneficial effect of TPE in long COVID.

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