Plasma Exchange in Covid-19 Patients With Anti-interferon Autoantibodies
Status:
Recruiting
Trial end date:
2022-03-22
Target enrollment:
Participant gender:
Summary
COVID-19 associated mortality remains high despite the advances in therapeutics such as
dexamethasone. The severity of COVID-19 results from direct viral cytotoxicity, and the
inflammatory response, which is associated with a hypercoagulable state, contribute to lethal
hypoxemic pneumonia. During the SARS-CoV-2 replication phase, infected cells secrete
chemokines and die by activating the immune system locally. A local inflammatory loop induces
tissue destruction, which activates the immune system's circulating cells, leading to another
amplifying loop called the cytokine storm. In these phenomena, the integrity of the
interferon pathway plays a significant role.
Specific impairment of the interferon pathway has been identified in a subset of patients and
is associated with high Covid-19 severity. This subset of patients presents preexisting
autoimmune disease mediated by autoantibodies directed against IFN. It represents 10.2%
(101/987) of patients admitted in ICU with COVID-19 pneumonia, and the observed mortality in
this subgroup is 40%.
The investigators hypothesized that plasma exchanges (PE) would eliminate these
autoantibodies while acting on other mechanisms of the pathogenesis of severe COVID-19, such
as cytokine storm or hypercoagulability(7).
The EPIC trial aims to demonstrate the efficacy of plasma exchange in the subpopulation of
patients with anti-interferon autoantibodies and severe COVID-19 hospitalized in intensive
care and on oxygen therapy, high flow or not, receiving non-ventilation or invasive
ventilation, on D28 survival.