Convalescent plasma for patients with severe COVID-19: a matched cohort study

Abstract

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods A matched cohort analysis of hospitalized patients with severe COVID-19. The impact of CP treatment on all cause in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on the 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. Overall in-hospital mortality was 14.9%. 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). There was also no significant difference in the overall rate of hospital discharge (rate ratio [RR} 1.28, 95% CI 0.91 − 1.81), but a subgroup analysis of patients 65-years-old or greater who received CP demonstrated a significantly increased hospital discharge rate among these patients (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 The use of CP in this study was a safe treatment for COVID-19. There was no overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Further adequately powered randomized studies should target this subgroup when assessing the efficacy CP treatment.

Convalescent plasma may be a possible treatment for COVID-19: A systematic review

“…Following removing duplicates and screening of titles and abstracts, we evaluated 153 articles in full text. Among these, we found 45 relevant articles (4RCTs, 11 controlled NRSIs, 7 non-controlled NRSIs and 23 case reports) [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] . Extracted details are presented in Table 1 (RCTs, controlled NRSIs, and non-controlled NRSIs) and table 2 (case report(series)).…”

“… No serious AEs. Donato et al [28] USA Prospective controlled study, SC Intervention 47; control 1340 Moderate-critically ill 500 ml(n = 36); 400 ml(n = 10); 200 ml(n = 1) Median time 8–15 days IgG Spike RBD > 1:500 HCQ,AZM,Steroids,Tocilizumab,Remdesivir CPT was safe and conferred effective transfer of immunity while preserving endogenous immune response Mild rash(n = 1) Ralph Rogers et al [29] USA A matched cohort analysis,SC Intervention 64,control 177 Severe ill One or two units 7 days after symptom onset SARS-CoV-2 IgG antibody index ＞1.4 Remdesivir, corticosteroids No overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Two patients who received CP were judged to have a TRALI reaction.…”

“…The patients included in the study had a wide range of age distribution, ranged from 4 to 100 years old. The patients’ conditions were variable, two RCTs [21] , [24] and three controlled NRSIs [26] , [28] , [33] included moderate to severely ill patients, one RCT included less-severe patients, and the clinical symptoms of patients in the 6 controlled NRSIs met the definitions of severe or life-threatening disease [29] , [31] , [32] , [37] , [41] , [42] . One RCT [22] and 4 controlled NRSIs [27] , [34] , [35] , [40] evaluated CP therapy in critically ill individuals.…”

“…Mortality outcomes were reported in 21 of the included 22 controlled studies and non-controlled NRSIs [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [42] . The mortality outcome was evaluated from controlled studies: 4RCTs and 11NRSIs( Fig.…”

Evidence favouring the efficacy of convalescent plasma for COVID-19 therapy

“…The literature search yielded 171 studies, of which 38 studies met the eligibility criteria. The present analyses included a total of eighteen clinical trials including five RCTs, 7,8,12,13,15 thirteen matched-control studies, 11,16,[25][26][27][17][18][19][20][21][22][23][24] and twenty case series or case reports 10,28,[37][38][39][40][41][42][43][44][45][46][29][30][31][32][33][34][35][36] containing 10,436 COVID-19 patient outcomes from around the world ( Table 1 and Table 2). The age of patients enrolled in these studies ranged from 24 to 100 years, with a greater proportion of men than women in most studies (proportion of women: 0% to 100%) (Supplemental Table 1).…”