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

Abstract

Background: Coronavirus disease 2019 (COVID-19), sweeping across the world, has created a worldwide pandemic. Effective treatments of COVID-19 are extremely urgent.Objective: To analyze the efficacy and safety of convalescent plasma (CCP) on patients with COVID-19.Methods: All the relevant studies were searched from PubMed, EMBASE,Cochrane library, Scopus, Web of Science, CBM, CNKI, Wan fang, VIP, Medrxiv, Biorxiv, and SSRN on July 19, 2021. PICOS criteria were as follows: (P) the study interests were human subjects with the infection of COVID-19; (I) the intervention of interest was CCP; (C) comparator treatments contained placebo, sham therapy, and standard treatment; (O) the primary outcome was mortality rates by the novel coronavirus. The secondary outcomes included the incidence of serious adverse events, the rate of ICU admission and mechanical ventilation (MV); the length of hospital stay; the duration of MV and ICU stay; the antibody levels, inflammatory factor levels, and viral loads. (S) Only randomized controlled trials (RCTs) of CCP were included. Subanalysis, quality assessment, sensitive analysis, and publication bias were conducted by two reviewers independently.Results: Sixteen RCTs were included and enrolled a total of 16,296 participants in this meta-analysis. The pooled data showed that no significant difference was observed in reducing the rate of overall mortality between CCP treatment group and placebo group (OR 0.96; 95% CI 0.90 to 1.03; p = 0.30; I2 = 6%). According to the results of subgroup analysis, severe or critical patients with CCP showed significant difference in reducing the 28-day mortality of compared with placebo (OR 0.58, 95% CI 0.36 to 0.93, p = 0.02, I2 = 0%). CCP groups have a significantly shorter duration of MV compared with the control group (weighted MD −1.00, 95% CI −1.86 to −0.14 d p = 0.02, I2 = 0%). No significant difference was observed in the length of hospital stay, the duration of ICU, and the rate of ICU and MV. There is no conclusive evidence about the safety of CCP.Conclusion: Convalescent plasma can significantly reduce the 28-day mortality of severe or critical COVID-19 patients and the duration of MV. However, more evidence was needed to prove the safety of convalescent plasma.

Convalescent plasma may not be an effective treatment for severe and critically ill covid-19 patients: A Systematic Review & Meta-Analysis of Randomized Controlled Trials

“…In the meta-analysis, with subgroup analyses of severe and critically ill COVID-19 patients, convalescent plasma could decrease the mortality rate in severe COVID-19 patients [36] , however, the data was majorly extracted from the observational research [36] . The recent meta-analysis of Cao et al also found that the convalescent plasma could decrease the mortality rate for severe or critical patients [37] . The meta-analysis results of Cao et al [37] differ from our study, as they only analyzed 28-days mortality data.…”

“…The recent meta-analysis of Cao et al also found that the convalescent plasma could decrease the mortality rate for severe or critical patients [37] . The meta-analysis results of Cao et al [37] differ from our study, as they only analyzed 28-days mortality data. Still, most studies [ 7 , 10 , 11 , 18 , 22 , 24 , 25 ] reported a risk of death at 30-, 35-, 60-, and 90-days were not included in the analysis.…”

“…Still, most studies [ 7 , 10 , 11 , 18 , 22 , 24 , 25 ] reported a risk of death at 30-, 35-, 60-, and 90-days were not included in the analysis. Meanwhile, the meta-analysis of Cao et al [37] did not define the diagnostic criteria for severe COVID-19 infection; thus, these two studies could not be included in the analysis. Of note, the sensitivity analysis showed that the convalescent plasma could not reduce the mortality risk, even though the studies of Agarwal A [23] and Bégin P [25] were excluded from the analysis.…”

Pharmacological treatment of COVID-19: an opinion paper

“…As a human blood product it can cause the same reactions as transfusions (allergic and anaphylactic reactions, hemolysis, fluid overload, etc. ), but studies consistently show that plasma transfusion is safe with effects similar to those of ordinary transfusions [44][45][46][47][48][49][50][51].…”

“…However, despite the justification for its use, the experience in other viral epidemics and its safety, there are still no clear results in terms of efficacy. It began to be used in moderate-severe COVID-19 with publication of observational studies and clinical trials [46][47][48], with systematic review and meta-analysis [45,46], which have provided inconclusive results. Furthermore, these trials were heterogeneous with respect to the characteristics of the convalescent plasma used (e.g.…”