Case Series: Maraviroc and pravastatin as a therapeutic option to treat long COVID/Post-acute sequalae of COVID (PASC) Provisionally Accepted

Bruce Patterson¹ Ram Yogendra^2* Jose Guevara-Coto³ Rodrigo Mora-Rodriguez³ Eric Osgood⁴ John Bream⁵ Mark Kreimer⁶ Devon Jeffers⁷ Purvi Parikh⁸ Cedric Rutland⁹ Gary Kaplan¹⁰ Michael Zgoda¹¹

• ¹IncellDx Inc, United States
• ²Lawrence General Hospital, United States
• ³University of Costa Rica, Costa Rica
• ⁴St. Francis Medical Center, United States
• ⁵Novant Health Kernersville Medical Center, United States
• ⁶New York Presbyterian Hospital, United States
• ⁷Stamford Hospital, United States
• ⁸Langone Medical Center, New York University, United States
• ⁹West Coast Land, Rutland Medical Group, United States
• ¹⁰Georgetown University Medical Center, United States
• ¹¹Creighton University School of Medicine, United States

Post-acute sequelae of COVID (PASC), or long COVID, is a multisystem complication of SARS-CoV-2 infection that continues to debilitate millions worldwide thus highlighting the public health importance of identifying effective therapeutics to alleviate this illness. One explanation behind PASC may be attributed to the recent discovery of persistent S1 protein subunit of SARS-CoV-2 in CD16+ monocytes up to 15 months after infection. CD16+ monocytes, which express both CCR5 and fractalkine receptors (CX3CR1), play a role in vascular homeostasis and endothelial immune surveillance. We propose targeting these receptors using the CCR5 antagonist, maraviroc, along with pravastatin, a fractalkine inhibitor, could disrupt the monocytic-endothelial-platelet axis that may be central to the etiology of PASC. Using five validated clinical scales (NYHA, MRC Dyspnea, COMPASS-31, modified Rankin, and Fatigue Severity Score) to measure 18 participants’ response to treatment, we observed significant clinical improvement in 6 to 12 weeks on a combination of maraviroc 300 mg per oral twice a day and pravastatin 10 mg per oral daily. Subjective neurological, autonomic, respiratory, cardiac and fatigue symptoms scores all decreased which correlated with statistically significant decreases in vascular markers sCD40L and VEGF. These findings suggest that by interrupting the monocytic-endothelial-platelet axis, maraviroc and pravastatin may restore the immune dysregulation observed in PASC and could be potential therapeutic options. This sets the framework for a future double-blinded, placebo-controlled randomized trial to further investigate the drug efficacy of maraviroc and pravastatin in treating PASC.