Convalescent Plasma Therapy in the management of COVID-19 patients-The newer dimensions

Abstract

Background COVID 19 infection caused by novel coronavirus with no specific established treatment. Convalescent Plasma Therapy has been authorized as an off-label therapeutic procedure. We assessed the outcome of convalescent plasma (CP) units versus standard treatment on the complete recovery, improvement and 28 days’ mortality of COVID 19 patients. Materials and methods The present was multi-centric case controlled observational prospective study. The study was conducted for a period of four and half months from July 15 2020 to 30 November 2020 after taking approval from the Expert Committee, Health & Family Welfare Department, Government of Odisha. Plasma therapy was applied on two groups of 1189 serious COVID patients (959 number of pre- critical and 230 number of critical patients) not responding to oxygen therapy. It was compared with non- transfused control group of 1243 patients (996 number of pre-critical and 247 number of critical patients). Results Discharge was better in (55.5%) transfused than (43%)in non-transfused pre-critical patients and the mortality was lower (44.3%) in transfused, (48.9%) than non-transfused critical patients respectively. Complete recovery was highest in those who were transfused with CP with neutralizing titer more than 1:160 (52.5%), 18–30 years’ age group (64%), females (53%), ‘O’ Rh D positive blood group (51.5%). There was no adverse reaction due to CP transfusion. Conclusions CP is effective in improving the recovery rate with earlier discharge and decrease in the 28 days’ mortality than in the control non-transfused group. CP with neutralizing antibody titer more than 1:160 has the best outcome with complete recovery and decrease in the mortality. It is more effective in treating pre-critical patients when transfused early, in female patients, in younger age group and in blood group ‘O’ Rh D positive.

CONVALESCENT plasma for COVID‐19: A meta‐analysis of clinical trials and real‐world evidence

“…A total of 4728 records were identified from databases, websites and citation searching. There were 47 studies 16 , 17 , 18 , 19 , 20 , 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 fulfilled the inclusion criteria and were used for the systematic review and meta‐analysis (Figure 1 ). Of 47 included studies, 21 were clinical trials 16 , 17 , 18 ,…”

“…Of 47 included studies, 21 were clinical trials 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 60 , 61 , 62 and 26 were observational studies. 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 Among clinical trials, there were 18 studies published in peer‐reviewed journals 16 , 17 , 18 , 19 , 20 , 21 , …”

“…All studies provided complete outcome data and were clear from reporting bias (Table S5 ). For observational studies, there were ten studies conducted in the USA 35 , 42 , 45 , 50 , 52 , 54 , 55 , 56 , 57 , 59 ; three in China 36 , 37 , 43 ; three in Poland 40 , 48 , 58 ; three in India 41 , 47 , 51 ; two in Turkey 34 , 39 ; and one each in United Arab Emirates, 38 Austria, 44 Brazil, 46 Qatar 49 and Argentina. 53 Almost of observational studies included patients with severe or critical COVID‐19 disease (Table 2 ).…”

“…The current systemic review and meta‐analysis aimed to summarize the existing data on the efficacy of CP in COVID‐19 patients, which remains a challenge to explore treatment for SARS‐CoV‐2 pandemic to respond the increasing of the incidence of SARS‐CoV‐2 infection. According to the eligible criteria, 47 studies 16 , 17 , 18 , 19 , 20 , 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 were included and critically evaluated. Corresponding to the results of our systematic review and meta‐analysis, the CP may be effective in reducing the mortality of CP‐treated COVID‐19 patients compared with non‐CP‐treated COVID‐19 patients, especially in severe or critical patients and in Asia region.…”

The Effectiveness of Convalescent Plasma for the Treatment of Novel Corona Virus Disease 2019: A Systematic Review and Meta-Analysis

“…A meta-analysis conducted by Luo et al ( 43 ) put forward that patients with severe COVID-19 benefit more from the CCP transfusion; so we conducted the subanalysis and we found that there was a significantly lower 28-day mortality rate in the severe and critical patients treated with CP compared with the control groups (41/276 vs. 47/199, P = 0.02, OR 0.58 95% CI 0.36–0.93). An observational prospective study ( n = 2,432) also offers an evidence that CP group has a lower mortality than the nontransfused group in the critical cases (44.3 vs. 48.9%) ( 47 ). Our analysis should be interpreted with caution as only one of the five RCTs showed a reduction in 28-day mortality, but the sample size of this study accounted for 46% of the weight in the meta-analysis, suggesting the results were largely dominated by this trial.…”