Icosapent ethyl (VASCEPA^®) as treatment for post-acute sequelae of SARS CoV-2 (PASC) vaccine induced injury and infection

Post-Acute Sequelae of SARS CoV-2 infection (PASC) is characterized by persistent symptoms of the acute COVID-19 illness beyond 4 weeks from initial symptom onset [1]. Evidence suggests that SARS-CoV-2 enters cells via the membrane-bound angiotensin-converting enzyme 2 receptor (ACE2) [2]. Olfactory bulb, lung and heart tissues have been found to have a higher density of the ACE2 enzyme, leading to a greater probability of SARS-CoV-2 infection in those tissues and therefore a higher likelihood of those tissues being involved in acute COVID-19 [2, 3]. Clinical experience has shown that these organs are also commonly affected by PASC, however, there is no evident indicator of which patients will ultimately be affected [4].

It is believed that the immune response and hyperinflammation play a key role in both acute COVID-19 infection as well as PASC [5]. Common symptoms of PASC include cardiac abnormalities, dyspnea, persistent anosmia, dermatologic changes (to include hair loss), sleep disturbances, arthralgias, fatigue, and depressed mood, among others [1]. Emerging research has also found a correlation between Covid-19 and increased microglia activity, leading to a reduced ability to perform daily neurological tasks [6]. Preliminary research has demonstrated that anti-inflammatory medications can treat the applicable symptoms of PASC as demonstrated by Conti et al. in the article; Icosapent Ethyl (VASCEPA^®) as a treatment for prolonged post-infectious Covid-19 symptoms.

VASCEPA^®/Epadel^®, an Icosapent ethyl (IPE), is an omega-3 fatty acid derivative that has demonstrated the ability to reduce cardiovascular risk, regulate endothelial function and contain anti-inflammatory properties [7], [8], [9]. IPE is approved for, and has been used for, persistent hypertriglyceridemia, despite maximum statin dose, and for cardiovascular risk reduction [10, 11]. The ANCHOR and MARINE trials both demonstrated reduced inflammatory markers in patients receiving IPE therapy, despite the fact that the mechanism of cardiovascular risk reduction is not fully understood [7, 12, 13]. Based on the positive results, however, cardiovascular risk reduction is believed to be due to the anti-inflammatory effects of the drug [7, 12]. While the anti-inflammatory mechanism is not completely understood either, new research on Eicosapentaenoic acid (EPA) has demonstrated promising evidence that omega-3 fatty acids interrupt the purinergic chemical transmission that normally leads to increased pain and inflammation [14].

A reduction in inflammatory effects may suggest that IPE is a viable treatment for PASC. In a continuation of the research conducted by Conti et al., this report details the results of several case studies in which PASC was treated with IPE. Following informed consent for an alternative treatment with IPE, all patients described saw significant improvement in their PASC symptoms after being treated with 2 g IPE twice daily for two weeks, followed by 1 g twice daily for two additional weeks.

Patient No. 1 is a 35 year old, healthy, caucasian man. He completed his 2nd dose of the Pfizer mRNA vaccine during the Winter 2021. Several days after vaccination he started to develop dizziness, vertigo, fatigue and shortness of breath during exertion. Acute coronary syndrome was ruled out in the emergency room and there were no obvious signs of myocarditis. Over the course of 2 months the patient used vitamins c and b in the form of a Myers cocktail, as well as zinc and vitamin d. Two months later, while continuing his prior treatment, he was prescribed Vascepa at 2 g, twice daily. After 2 weeks, he reported resolution of symptoms. He was then prescribed IPE at 1 g, twice daily, in order to taper for two more weeks. At the one month follow up, he stated that symptoms completely resolved.

Patient No. 2 is a 52 year old, overweight, caucasian woman. She completed her final vaccine dose of the Moderna mRNA vaccine in February 2021 and claimed to not have ever tested positive for Covid-19 infection. A few weeks after her last vaccine she developed bilateral hip and right knee arthralgia. The patient previously had a right knee ACL repair in 2012. Prior to the onset of arthralgia, her right knee was aggravated by exercise. She was using 10 mg of prednisone per day for joint pain, as well as a multivitamin, zinc and vitamin d. Following the onset of arthralgia, standing for long periods of time aggravated her joint pain. She additionally reported experiencing insomnia and fatigue. The patient was prescribed Vascepa at 2 g, twice daily, in December 2021, at which time she discontinued prednisone use. After 2 weeks of Vascepa treatment, she reported resolution of symptoms. She was then prescribed IPE at 1 g, twice daily, in order to taper for two more weeks. At the one month follow up, she stated that symptoms were completely resolved as she no longer had joint pain unless vigorously exercising and sleep and energy levels had improved to baseline.

Here, we described two patients of different sexes and ages who experienced complications after receiving their second dose of the COVID-19 mRNA vaccine in the winter of 2021. After two weeks of treating each patient with two g of Vascepa BID and receiving 1 g of Icosapent ethyl BID for two more weeks, both patients experienced complete resolution of symptoms. This is likely due to the anti-inflammatory properties of the drug [1], [2], [3]. It is important to note that Icosapent ethyl was used to taper the patients off Vascepa.

The 35 year old male tried other treatments that have been unsuccessful, while the 52 year old female was prescribed Vascepa from the start. Each of them experienced full recovery post treatment. It should be noted that each of the patients were only on Vascepa and no other drugs. It is known that the use of Vascepa/Epadel helps with an imbalance of omega-3 fatty acids [4, 5]. While further research is needed to confirm the validity of the findings, Vascepa has shown promising results in the treatment of adverse effects caused by the mRNA vaccine.

We report IPE as a successful treatment for post vaccine complications in two patients. As the pandemic is progressing, prevalence of post vaccine complications continues to rise. Further research is needed to fully understand the efficacy of IPE in PASC and post vaccination complications.