Convalescent plasma therapy in patients with COVID-19

Abstract

We would like to express our sincere thanks to the author's interest in our paper, and we are also grateful for her adding invaluable contribution to improve the value of our paper. Unfortunately, during the current pandemic, more than 1 million people died because of COVID-19, and millions of people needed hospitalization, and some needed intensive care unit (ICU) support. Until the active vaccination against SARS-CoV-2 reaches large populations, effective treatments and supportive approaches are crucial to reduce the case fatality rate (CFR) and the need for ICU and hospitalization. Most of the previous studies about SARS-CoV-2 antibody containing convalescent plasma (CP) are not randomized. There is only a limited number of randomized studies, and in most of these randomized studies, they did not use age, gender, and comorbidity matched control group for comparison. Older age and comorbidities such as diabetes mellitus, hypertension, or cardiac disease are the risk factors for a more aggressive clinical course in patients with COVID-19 [1,2]. For this reason, in the design of this study, we preferred to use an age, gender, and comorbidity matched group for comparison. The study group was severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888), and the control group was composed of at 1:1 ratio (n = 888). In total, the data of laboratory-confirmed 1776 COVID-19 patients were analyzed retrospectively. Both groups were consisting of severe and critically ill COVID-19 patients; in addition, selecting an age, gender, and comorbidity matched control group made the results of the comparison stronger [3]. The author reasonably wanted to know if the use of steroids and/or anticoagulants was similar in patients across the groups [4]. However, this data was not available. Instead, the data about the use of favipravir, lopinavir + ritonavir, hydroxychloroquine, high dose vitamin C, and azithromycin was available, and we demonstrated them in Table 1. The

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

“…The literature search yielded 171 studies, of which 38 studies met the eligibility criteria. The present analyses included a total of eighteen clinical trials including five RCTs, 7,8,12,13,15 thirteen matched-control studies, 11,16,25–27,17–24 and twenty case series or case reports 10,28,37–46,29–36 containing 10,436 COVID-19 patient outcomes from around the world ( Table 1 and Table 2 ). The age of patients enrolled in these studies ranged from 24 to 100 years, with a greater proportion of men than women in most studies (proportion of women: 0% to 100%) ( Supplemental Table 1 ).…”

“…Similarly, when we aggregated mortality data from the thirteen matched-control studies, patients transfused with convalescent plasma exhibited a lower mortality rate compared to non-transfused patients (20% vs. 29% mortality; OR: 0.50, 95% CI: 0.37, 0.67, P < 0.001, I 2 = 61%) ( Table 1 and Figure 1 ). One study (Altuntas et al 27 ) represented the entire source of heterogeneity (Δ I 2 = 61%) among matched-control studies; however, this study was included in subsequent analyses as the OR for pooled matched-control data was similar when excluding the Altuntas et al 27 study (17% vs. 30% mortality; OR: 0.44, 95% CI: 0.38, 0.51, P < 0.001, I 2 = 0%).…”

Efficacy of convalescent plasma therapy in severe COVID-19 patients

“…Similar results were found in 30-day mortality rates (21.6% and 26.7%) [ 36 ]. There was a need for more mechanical ventilators in the CP group after 20 days in a study conducted in Turkey [ 37 ]. Our study showed that administering CP within the first five days in support of these data shortened hospitalization.…”

Plasma convalescente como alternativa ao tratamento aplicado à Covid-19

“…No entanto, existem algumas questões que precisam ser claramente determinadas para otimizar o tratamento com plasma convalescente, como a eficácia e segurança do tratamento, o volume ideal de plasma, o número de transfusões, o intervalo entre as transfusões, o título ideal de anticorpo neutralizante, eficácia dos processos de inativação de patógenos, tempo e intervalos de doação ideais. Por isso, há necessidade de estudos prospectivos e randomizados em grande escala sobre o tratamento (ALTUNTAS et al, 2020).…”

“…Ademais, após realizar uma análise de outros trabalhos, concluiu-se que a duração na unidade de terapia intensiva (UTI), a taxa de suporte de ventilação mecânica (VM) e suporte de vasopressor foram menores no grupo de pacientes que fizerem uso de plasma convalescente (PC) em comparação com o grupo controle. A taxa de letalidade foi de menor no grupo PC do que no grupo controle (ALTUNTAS et al, 2020).…”