E3 PreliminaryPreliminaryPEM unclearCase-ControlPeer-reviewedReviewed
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Efficacy of Repeat Immunoadsorption.
Tölle, Markus, Freitag, Helma, Antelmann, Michaela et al. · Journal of clinical medicine · 2020 · DOI
Quick Summary
This study tested a blood-cleaning treatment called immunoadsorption (IA) on five ME/CFS patients who had previously improved with this therapy. About two years later, they received the treatment again using a slightly modified approach. Four of the five patients showed improvement in their symptoms that lasted 6-12 months, and the treatment was well tolerated with no serious side effects.
Why It Matters
This study provides preliminary evidence that immunoadsorption may be an effective, tolerable treatment for a subset of ME/CFS patients, particularly those with β₂AR-antibodies. If validated in larger controlled trials, IA could offer a potential therapeutic option for patients with this debilitating autoimmune-mediated disease.
Observed Findings
- Four of five patients showed rapid improvement in multiple clinical symptoms following repeat IA treatment
- Treatment achieved 80-90% reduction in both total IgG and β₂AR-AB levels
- Symptom improvement persisted for 6-12 months post-treatment
- The modified IA protocol was well tolerated with no reported serious adverse effects
- One patient experienced no clinical improvement despite similar antibody reduction
Inferred Conclusions
- Repeat immunoadsorption demonstrates clinical efficacy in a subset of ME/CFS patients with prior treatment response
- The therapeutic effect may be mediated through reduction of β₂AR-antibodies
- Immunoadsorption warrants further investigation in larger, controlled clinical trials for ME/CFS
Remaining Questions
- Why did one patient fail to improve despite adequate antibody reduction, and what patient factors predict treatment response?
- Would repeat IA at different time intervals or using alternative protocols further extend symptom improvement duration?
- How does this treatment perform in ME/CFS patients without prior IA exposure or those without elevated β₂AR-antibodies?
What This Study Does Not Prove
This small pilot study does not establish that IA is effective for all ME/CFS patients or prove that β₂AR-antibodies are the cause of ME/CFS in general. It also cannot determine whether symptom improvement was due to IA treatment, natural recovery, placebo effect, or other unmeasured factors, as there was no control group or blinding.
Tags
Symptom:Fatigue
Biomarker:AutoantibodiesBlood Biomarker
Phenotype:Infection-Triggered
Method Flag:PEM Not DefinedNo ControlsSmall SampleExploratory OnlyWeak Case Definition
Metadata
- DOI
- 10.3390/jcm9082443
- PMID
- 32751659
- Review status
- Editor reviewed
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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