Convalescent plasma therapy in patients with moderate-to-severe COVID-19: A study from Indonesia for clinical research in low- and middle-income countries

Abstract

Background: We explored the outcome of convalescent plasma (CP) treatment in patients with moderate and severe coronavirus disease 2019 and investigated variables for the design of further trials in Indonesia. Methods: Hospitalised patients with moderate (n = 5) and severe (n = 5) COVID-19 were recruited and transfused with CP from donors who recovered from mild (n = 5), moderate (n = 5), or severe (n = 1) COVID-19. Neutralising antibodies (NAbs) to the virus were measured at the end of the study using a surrogate virus neutralisation test as an alternative to the plaque reduction assay. Clinical improvement was assessed based on the modified World Health Organization Research and Development Blueprint six-point scale, Brixia Chest-X-Ray scoring, and laboratory parameters. The study was registered at ClinicalTrials.gov (NCT04407208). Findings: CP transfusion in three doses of 3 mL/kg of recipient body weight at 2-day intervals was well tolerated. Good clinical improvement was achieved in all patients with moderate disease and in two patients with severe disease. Most patients at baseline had detectable NAbs with median inhibition rates comparable to those of the donors (90¢91% vs. 86¢31%; p = 0¢379). This could be due to the unavailability of pre-donation NAb testing and postponed CP administration that required communal consent. Interpretation: This study highlights the safety of CP therapy. Although improvements were observed, we could not conclude that the outcomes were solely due to CP treatment. Further randomised controlled trials that cover different disease stages with pre-donation NAb measurements using locally applicable strategies are warranted.

Convalescent plasma therapy in obese severe COVID-19 adolescents: Two cases report

“…However, the safety and effectiveness of CPT in the pediatric patient population have not been evaluated [ 14 ]. The Indonesian Pediatric Society (IPS) recommends giving convalescent plasma therapy for children weighing >40 kg at a dose of 200–500 mL and a dose of 10–15 mL/kg BW for children weighing <40 kg [ 15 ]. There are three critical factors associated with CPT efficacy.…”

Convalescent plasma therapy against the emerging SARS-CoV-2 variants: Delineation of the potentialities and risks

“…Furthermore, donors consenting to give plasma must fulfill the exact requirements as the donors consenting to contribute blood; for example, for CPT, the donor can be harmful if not tested for the SARS-CoV-2. The donor should be free of any COVID-19 symptoms during the CP donation [ 42 , 90 , 91 ]. The production of CP for treating patients can be hindered by the lack of NAbs in the plasma of the donor, and these antibodies persist for a period of few weeks to months only.…”

The Rise of SARS-CoV-2 Variants and the Role of Convalescent Plasma Therapy for Management of Infections

“…CP treatment also requires large infusion volumes (200–2400 mL) [ 98 ], and there is no available standardized transfusion dose of CP, i.e., the dose depends on the patient. The time of administration also determines the outcome; i.e., the best outcome occurs in those recipients/patients who have received CP transfusion before the development of the humoral immune response [ 99 ].…”

“…After SARS-CoV-2 seroconversion, the development of SARS-CoV-2 antibodies from infection (or immunization) can be detected in blood samples, and in those infected, the increased levels of antibodies are accompanied by a decline in viral load [ 99 , 145 ]. For CPT, plasma administration prior to SARS-CoV-2 seroconversion (<5 days post-exposure) is critical to avoid disease progression from mild to severe.…”