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

Abstract

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.

Convalescent Plasma Therapy for COVID-19: State of the Art

“…Many more case reports and small case series are accumulating in the literature; successful treatment was reported in 3 cases with ARDS and mechanical ventilation using two 250-ml CP doses (titrated with ELISA only) in South Korea ( 43 , 87 ), in 2 cases from Iraq ( 88 ), in 8 out 10 severe cases from Mexico ( 89 ), in 20 out of 26 severe cases from Turkey ( 90 ), in a kidney transplant recipient from China ( 91 ), in a case with severe aplastic anemia in Poland ( 92 ), in a case with X-linked agammaglobulinemia in Spain ( 93 ), and in 1 patient with marginal-zone lymphoma treated with bendamustine and rituximab in the United Kingdom ( 94 ). Centers in the United States reported successful treatment with CP in 18 out of 20 patients in a series ( 95 ), in 27 out of 31 patients with severe to life-threatening disease in another series ( 96 ), in one case with myelodysplastic syndrome ( 97 ), in a critically ill obstetric patient (in combination with remdesivir) ( 98 ), and in an allogeneic stem cell transplant recipient ( 99 ).…”

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

“…As a result, our analysis may underestimate the mortality reduction acheivable through early administration of convalescent plasma for COVID-19. 25 Wisconsin, USA 27 Forest plot illustrating odds ratios (OR) and 95% confidence intervals for controlled studies and aggregate fixed effect models. Fixed effect ORs for Duan et al 26 , Rasheed et al 19 , Perotti et al 23 , Hegerova et al 21 , Zeng et al 9 , Donato et al 10 , Liu et al 22 , Salazar et al 11 , Gharbharan et al 8 , Xia et al 12 , Abolghasemi et al 24 , and Li et al 7 are represented in blue.…”

Factors Associated with Good Patient Outcomes Following Convalescent Plasma in COVID-19: A Prospective Phase II Clinical Trial

“…Preliminary data from clinical trials and observational studies targeting COVID-19 suggest that administration of convalescent plasma may reduce mortality, hospital length of stay, and time on mechanical ventilation with minimal adverse side effects in patients with severe or life-threatening disease [18][19][20][21][22][23]. Consistent with earlier studies, treatment may be most efficacious for severe COVID-19 when administered closer to symptom onset [21][22][23][24][25]. The purpose of this study is to describe the course of illness among 38 patients hospitalized with severe or life-threatening COVID-19 who received convalescent plasma as part of an FDAapproved phase 2 clinical trial.…”

“…The literature suggests that convalescent plasma may be more beneficial when administered sooner to disease onset [16,17]. Data recently published on COVID-19 suggested favorable clinical outcomes when convalescent plasma is given earlier in the course of disease [21][22][23][24][25][27][28][29], and with higher content of anti-SARS-CoV-2 antibody [27,29]. Our finding is consistent with the literature that treating patients with COVID-19 disease with convalescent plasma earlier in the disease course, and within the first 2 weeks following symptom onset may promote recovery [30].…”