Preliminary data from a small study suggests convalescent plasma may have some efficacy in patients with severe COVID-19. The retrospective, propensity score-matched case-control study involved 39 patients who received convalescent plasma for severe or life-threatening COVID-19 at Mount Sinai Hospital in New York from 20 March to 20 April. The patients, who were an average age of 55 and had few baseline comorbidities other than obesity (mean mass body index, 31.7), received convalescent plasma under compassionate use guidelines an average of 4 days after admission. For the analysis, they were matched 1:4 to 156 control patients admitted during the same period.
Convalescent plasma recipients and control patients were 100% matched on supplemental oxygen requirements on day 0, but by day 14 after transfusion, oxygen requirements had worsened in 17.9% of convalescent plasma patients, compared with 28.2% of the control patients (adjusted odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75 to 0.98; chi-square test P value = 0.025).
At the end of the study, 12.8% of the convalescent plasma patients and 24.4% of the control patients had died. Following adjustment for the duration of symptoms before admission and exposure to therapeutic anti-coagulation and broad-spectrum antibiotics, the analysis showed significant survival benefit for convalescent plasma (adjusted hazard ratio, 0.34; 95% CI, 0.13 to 0.89; chi-square test P = 0.027).
No serious adverse events were judged to be caused by convalescent plasma transfusion. The authors say larger, randomized studies are needed to confirm the findings.
"This initial assessment offers evidence in support of convalescent plasma transfusion as an effective intervention in COVID-19," they write. "Preliminary data suggest a mortality benefit, but greater numbers and a randomised trial design are needed to draw definitive conclusions about the efficacy of convalescent plasma for the treatment of COVID-19."
Convalescent plasma was granted emergency use authorisation by the US Food and Drug Administration in August, but critics, including an expert panel gathered by the National Institutes of Health, say there are insufficient data to recommend for or against the use of convalescent plasma for COVID-19 treatment.
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments1. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses2,3. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed1,2. This retrospective, propensity score–matched case–control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score–matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75–0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13–0.89; chi-square test P = 0.027). Convalescent plasma is potentially effective against COVID-19, but adequately powered, randomized controlled trials are needed.
Authors
Sean TH Liu, Hung-Mo Lin, Ian Baine, Ania Wajnberg, Jeffrey P Gumprecht, Farah Rahman, Denise Rodriguez, Pranai Tandon, Adel Bassily-Marcus, Jeffrey Bander, Charles Sanky, Amy Dupper, Allen Zheng, Freddy T Nguyen, Fatima Amanat, Daniel Stadlbauer, Deena R Altman, Benjamin K Chen, Florian Krammer, Damodara Rao Mendu, Adolfo Firpo-Betancourt, Matthew A Levin, Emilia Bagiella, Arturo Casadevall, Carlos Cordon-Cardo, Jeffrey S Jhang, Suzanne A Arinsburg, David L Reich, Judith A Aberg, Nicole M Bouvier
[link url="https://www.cidrap.umn.edu/news-perspective/2020/09/covid-19-scan-sep-15-2020?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_medium=email&_hsmi=95466012&_hsenc=p2ANqtz-_xfZfLghvLB20CIEwE2HFczf3WEUSBq163iKlBrG9-HvWFbI2taDX08nFkYcJOfe_rvwp4ZmOU5t_S_RN-eyMZICuwPw&utm_content=95466012&utm_source=hs_email"]CIDRAP material[/link]
[link url="https://www.nature.com/articles/s41591-020-1088-9"]Nature Medicine abstract[/link]