Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19

Li, Ling; Zhang, Wei; Hu, Yu; Tong, Xunliang; Zheng, Shangen; Yang, Juntao; Kong, Yujie; Ren, Lili; Qing, Wei; Mei, Heng; Hu, Cao; Tao, Cuihua; Yang, Ru; Wang, Jue; Yu, Yinhua; Guo, Yong; Wu, Xiaoxiong; Xu, Zhihua; Zeng, Li; Xiong, Nian; Chen, Lifeng; Wang, Juan; Ning, Man; Liu, Yu; Xu, Haixia; Deng, E.; Zhang, Xuejun; Li, Chenyue; Wang, Conghui; Su, Shisheng; Zhang, Linqi; Wang, Jianwei; Wu, Yanyun; Liu, Zhong

doi:10.1001/jama.2020.10044

Cited by 1,184 publications

(1,722 citation statements)

References 14 publications

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“…They go on to describe that mortality appears to be related to the incidence of disease per capita and the resources available in the local healthcare system to absorb and care for the number of cases in need. (16) This may well be part of the phenomenon of less aggressive appearing disease seen in the Dane County and Madison area. Dane County, with a population of approximately 550,000, has an infection rate of 143/100,000 population and a mortality rate of only 5/100,000.…”

Section: Discussionmentioning

confidence: 99%

Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

Hartman

Hess²

2020

Preprint

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Background: SARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.Methods: Hospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.Results: 31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.Conclusion: Our results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

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Section: Discussionmentioning

confidence: 99%

Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

Hartman

Hess²

2020

Preprint

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“…One of the main hypotheses to explain the potential clinical benefits of CCP is the presence of SARS-CoV-2 neutralizing antibodies (nAb) (8,9). Therefore, several groups have included nAb titers as a criterion for the selection of CCP units to be transfused (10,11). However, the determination of nAb titers using a virus neutralization assay is not readily accessible and alternative ways have been considered.…”

Section: Main Textmentioning

confidence: 99%

Longitudinal analysis of the humoral response to SARS-CoV-2 spike RBD in convalescent plasma donors

Perreault

Tremblay

Fournier

et al. 2020

Preprint

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Héma-Québec, the blood supplier in the Province of Quebec, Canada, collects and tests convalescent plasma used in a clinical trial to determine the clinical efficacy of this product for the treatment of hospitalized COVID-19 patients. So far, we have collected 1159 plasma units from 282 COVID-19 convalescent donors. The presence of antibodies to the receptor binding domain (RBD) of SARS-CoV-2 spike protein in convalescent donors was established at the first donation. Seropositive donors were asked to donate additional plasma units every six days. Until now, 15 donors have donated at least four times and, in some cases, up to nine times. This allowed us to perform a longitudinal analysis of the persistence of SARS-CoV-2 RBD-specific antibodies in these repeat donors, with the first donation occurring 33-77 days after symptoms onset and donations up to 71-114 days after symptoms onset thereafter. In all donors, the level of antibodies remained relatively stable up to about 76 days after symptoms onset but then started to decrease more rapidly to reach, in some convalescent donors, a seronegative status within 100-110 days after symptoms onset. The decline in anti-RBD antibodies was not related to the number of donations but strongly correlated with the numbers of days after symptoms onset (r = 0.821). This suggests that de novo secretion of SARS-CoV-2 RBD antibodies by short-lived plasma cells stopped about 2-3 months after disease onset, an observation that has important implications for convalescent plasma collection and seroprevalence studies undertaken several months after the peak of infection.

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“…This is in line with one of the rst published randomized clinical trials of convalescent plasma, in which Li and colleagues found clinical improvement was limited to those with without life-threatening disease, with 91% improvement in the plasma group compared to 68% in the control arm. (15) We observed a high rate clinical improvement among mechanically ventilated patients who received COVID-19 convalescent plasma. Although 4 (29%) of our patients with life-threatening disease died, 9 (64%) has improve respiratory by 14 days after transfusion.…”

Section: Discussionmentioning

confidence: 79%

Hospitalized COVID-19 Patients Treated With Convalescent Plasma in a Mid-size City in The Mid West

Hartman

Hess

2020

Preprint

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BackgroundSARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.MethodsHospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.Results31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.ConclusionOur results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

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Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19

Cited by 1,184 publications

References 14 publications

Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

Longitudinal analysis of the humoral response to SARS-CoV-2 spike RBD in convalescent plasma donors

Hospitalized COVID-19 Patients Treated With Convalescent Plasma in a Mid-size City in The Mid West

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