Convalescent Plasma for Patients With Severe Coronavirus Disease 2019 (COVID-19): A Matched Cohort Study

Abstract

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.

Convalescent Plasma for the Treatment of Severe COVID-19

“…No significant difference in the mortality risk or in the rate of hospital discharge was observed by Rogers and colleagues between a group of patients treated with CP and control patients, 34 although there was a suggestion of improved outcome among elderly patients.…”

“… 7 (5 mild and 2 severe) - Large sample size - Non RCT Xia et al 33 Case-control retrospective study/China 138 severe or LT COVID-19 pts/1568 severe or LT COVID-19 pts - CP could improve the symptoms and mortality in COVID-19 pts. NR - - Single center study - Large control population of pts - Retrospective study Rogers et al 34 Matched cohort study 64 severe COVID-19 pts/177 severe COVID-19 pts - No significant difference in risk of mortality or rate of hospital discharge was observed. 2 TRALI - Single center study - Non RCT Ibrahim et al 35 Prospective study/USA 38 severe or LT COVID-19 pts/- - Patients receiving CP early had significant lower mortality and shorter hospital length of stay than patients with more advanced COVID-19.…”

Treatment of Severe COVID-19 with Convalescent Plasma in Bronx, NYC

“…In a case-control study that also did not show a signal of CCP efficacy, Rogers et al found a higher rate of hospital discharge in patients 65 years or older ( 47 ). In their study, 14% of CCP recipients were Black/African American, 31% were Caucasian/White, 42% were Hispanic/Latinx, 34% had hypertension, 25% had diabetes, and all received 2 units of CCP.…”

“…Among CCP recipients at least 65 years in our study, 98% received corticosteroids concurrently with or before CCP. More CCP recipients than controls also received corticosteroids in the Rogers et al study, which did not find evidence of CCP benefit ( 47 ). In addition, although not statistically significant, a higher proportion of CCP recipients than controls received corticosteroids in the Li et al RCT, in which there was not a signal of CCP efficacy and the median age was 70 years ( 25 ).…”

Will SARS-CoV-2 Infection Elicit Long-Lasting Protective or Sterilising Immunity? Implications for Vaccine Strategies (2020)

“…This may re-ignite the debate about the role that ADE could play in poor patient outcomes. Strong humoral responses and B cell activity in severely ill patients may also suggest a pathogenic role for antibodies ( 102 ), but the use of convalescent plasma has so far not been shown to worsen disease outcome, with some evidence for a slightly better outcome in elderly patients ( 103 ). Based on current evidence, it is therefore unlikely that ADE is driving the severity of disease in SARS-CoV-2 infection.…”