Feasibility of convalescent plasma therapy in severe COVID‐19 patients with persistent SARS‐CoV‐2 viremia

Abstract

This study aims to assess the efficacy and safety of convalescent plasma therapy (CPT) in COVID‐19 critically ill patients with protracted severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNAemia. A retrospective cohort study was conducted in intensive care unit (ICU). All patients with severe COVID‐19 pneumonia for whom RNAemia remained positive more than 14 days after onset of the infection were included and given CPT. The primary objective was to evaluate SARS‐CoV‐2 RNAemia 7 days (D7) after CPT. A total of 14 patients were included and they received a median CPT volume of 828 ml (range: 817–960). CPT was administered in a median time of 14 days after ICU admission. At D7, 13/14 patients had negative SARS‐CoV‐2 blood PCR and one patient had negative blood PCR 11 days after CPT. At D7 and at D14, the clinical status was improved in 7/14 and 11/14 patients, respectively. The 28‐day mortality rate was 14%. No CPT‐related adverse effects had been reported. CPT is safe and may be efficient in patients with protracted RNAemia admitted in ICU for severe COVID‐19 pneumonia. Randomized controlled trials are needed to confirm these results.

Navigating the Post-COVID-19 Immunological Era: Understanding Long COVID-19 and Immune Response

“…Among the emerging therapies, Paxlovid has gained attention as a promising antiviral treatment with potential efficacy against SARS-CoV-2. Paxlovid, also known as PF-07321332/ritonavir, is an oral antiviral medication developed by Pfizer for the treatment of COVID-19 [139]. It functions as a protease inhibitor, targeting the SARS-CoV-2 virus's main protease (Mpro).…”

“…Overall, the judicious use of generic drugs in host response treatments represents an essential component of the multifaceted approach to combatting COVID-19. Allergic reactions Improved clinical outcomes [157] Limited availability [134,158] Antiviral therapies Potential side effects (e.g., immune reactions, Reduction in disease severity [139] gastrointestinal symptoms, Improved clinical recovery [67] hypersensitivity reactions) [159] Paxlovid treatment Limited availability, side effects, effectiveness varies against specific strains of the virus Reduction in viral load, authorized for emergency use, complement to vaccination, alleviate symptoms [139,140] Immune modulators Risk of immune suppression Reduction in inflammation [67] Increased risk of secondary infections Improved outcomes in severe cases [159][160][161] Convalescent plasma therapy Allergic reactions Potential reduction in disease severity [162] Transfusion-related lung injury Improved outcomes when administered early [142] Novel immune therapies Potential risks (e.g., immune reactions) Novel therapeutic approaches [143] Thrombosis Potential for reducing inflammation [147] mRNA vaccines Cold storage requirements High efficacy in preventing COVID-19 [163] Limited global supply Induction of robust immune response [164] Possible adverse events (e.g., allergic reactions) Potential for reducing inflammation [165] Nanoparticle vaccines Development and manufacturing challenges Enhanced stability and shelf life [166] Need for further clinical validations Potential for targeted delivery [167] Cell-based therapies Limited availability Potential for personalized treatment [168] Immune rejection Multimodal immunomodulatory effects [169] Long-term safety concerns Potential for targeted delivery [170,171] Gene editing technologies Off-target effects Precise targeting of viral genetic material [172] Ethical considerations Potential for preventing viral replication [173] Limited clinical applications Enhanced stability and shelf life…”

The spike glycoprotein of highly pathogenic human coronaviruses: structural insights for understanding infection, evolution and inhibition

“…Convalescent plasma therapy has proven effective in treating patients infected by SARS‐CoV and MERS‐CoV [ 106 , 107 , 108 , 109 ]. Limited clinical data available for SARS‐CoV‐2 also suggested that this therapy was effective in reducing viral load and improving the survival of infected individuals [ 110 , 111 , 112 , 113 ]. As a result, convalescent plasma therapy was issued an emergency use authorization (EUA) and employed in China during the early stages of COVID‐19.…”

Long-Term Immunity and Antibody Response: Challenges for Developing Efficient COVID-19 Vaccines

“…Some studies suggest that antibodies are not enough to eliminate viruses, which is confirmed by the lack of a sharp drop in viral load post-seroconversion [ 61 ]. Monitoring the clinical outcome of convalescent plasma transfer therapy (CPTT) may be one approach to determining antibody efficacy [ 62 ]. CPTT trials in SARS-CoV-2 have yielded mixed results on the preventive role of neutralizing antibodies.…”

“…CPTT trials in SARS-CoV-2 have yielded mixed results on the preventive role of neutralizing antibodies. In case–control trials for severe SARS-CoV-2, CPTT initially showed encouraging results, with some research suggesting that earlier treatment was more effective [ 62 , 63 ]. SARS-CoV-1 patients were also found to benefit from early CPTT [ 64 ].…”