Early high-titer convalescent plasma therapy in patients with moderate and severe COVID-19

Abstract

Background and objectives: The use of COVID-19 convalescent plasma (CCP) has been approved by the FDA. We assessed the outcome of patients with moderate and severe COVID-19 following convalescent plasma therapy and the association with variables such as antibody titer in CCP units and transfusion time. Materials and methods: In this prospective cohort study, 3097 patients with moderate and severe COVID-19 (according to WHO Progression Scale) had heterogeneous demographic and clinical characteristics received plasma with an unknown titer at the transfusion time. Firstly, information about age, sex, blood group, the time interval from hospitalization to CCP transfusion, underlying disease, and antibody titer with the outcome were investigated. Then, multivariate logistic regression and area under the curve (AUC) were performed for the association between disease severity and intubation variables with transfusion time and outcome. Results: Patients with younger age receiving CCP in the first five days of hospitalization had lower mortality (P < 0.0001). Moreover, patients without the underlying disease had lower mortality (P < 0.001). The mortality rate also decreased in severe patients who were intubated receiving CCP for less than five days (P < 0.001). In patients with moderate severity (score less than 5) who received IgG antibody levels above 1:320 in less than five days had lower mortality (P < 0.0001). Conclusion: Our findings suggested that COVID-19 patients with the moderate type of disease receiving CCP units with high antibody titers in the early stages of the disease experienced greater effectiveness of CCP therapy.

A Detailed Overview of Immune Escape, Antibody Escape, Partial Vaccine Escape of SARS-CoV-2 and Their Emerging Variants With Escape Mutations

“…Several clinical trials have been performed to understand the efficiency of CP to patients with COVID-19 ( 225 ). Several other studies were performed to comprehend the neutralizing capacity, nAb titer level, and other factors ( 226 ). However, recent variants of SARS-CoV-2 with the new mutations have created an alarm for the neutralizing capacity of CP to treat the disease ( 227 ).…”

Clinical characteristics and severity of beta and delta variants of SARS-CoV-2 and the effect of vaccine on delta variants

“…Some studies have shown that convalescent plasma therapy can reduce mortality and the length of hospitalization in patients with moderate COVID-19 ( Basheer et al., 2021 ). Convalescent plasma with a high IgG antibody titer at the early stage of disease is more effective for the treatment of patients with moderate COVID-19 in Convalescent plasma therapy( Fazeli et al., 2022 ).…”

Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma A Systematic review and meta-analysis

“…In this framework, three matched cohort studies 98,109,114 enrolling 330 participants and 12 case series 54,[134][135][136][137][138][139][140][141][142][143][144] enrolling 29,361 participants were included in this subgroup analysis. In this subgroup meta-analysis, treatment with COVID-19 convalescent plasma containing high antibody levels was associated with a 15% decrease in mortality rates compared to convalescent plasma containing low antibody levels, with a pooled risk ratio estimate of 0.85 (95% CI, 0.73 to 0.99).…”

“…In this context, we examined within study mortality rates among patients treated with convalescent plasma earlier compared to those treated later in the COVID-19 disease course. This subgroup analysis examined 26 studies, including: 2 randomized clinical trials 14,41 enrolling 5,990 participants, 7 matched cohort studies 69,72,97,101,[109][110][111] enrolling 1,928 participants, and 17 case series [136][137][138]140,[145][146][147][148][149][150][151][152][153][154][155][156][157] enrolling 10,530 participants. In this subgroup meta-analysis, treatment with convalescent plasma earlier in the COVID-19 disease course was associated with a 37% decrease in mortality rates compared to treatment later in the disease course, with a pooled risk ratio estimate of 0.63 (95% CI, 0.48 to 0.82).…”