Convalescent plasma use in the USA was inversely correlated with COVID-19 mortality

Abstract

Background. The US Food and Drug Administration authorized Convalescent Plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 patients during the first year of the pandemic for the US.Methods. We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data.Results. CCP usage per admission peaked in Fall 2020, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, after randomized controlled trials failed to show a reduction in mortality, CCP usage per admission declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (r = -0.52, P = 0.002) between CCP usage per hospital admission and deaths occurring two weeks after admission, and this finding was robust to examination of deaths taking place one, two or three weeks after admission. Changes in the number of hospital admissions, SARS-CoV-2 variants, and age of patients could not explain these findings. The retreat from CCP usage might have resulted in as many as 29,000 excess deaths from mid-November 2020 to February 2021.Conclusions. A strong inverse correlation between CCP use and mortality per admission in the USA provides population level evidence consistent with the notion that CCP reduces mortality in COVID-19 and suggests that the recent decline in usage could have resulted in excess deaths.Funding. There was no specific funding for this study. AC was supported in part by RO1 HL059842 and R01 AI1520789; MJJ was supported in part by 5R35HL139854. This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services; Office of the Assistant Secretary for Preparedness and Response; Biomedical Advanced Research and Development Authority under Contract No. 75A50120C00096.

Convalescent Plasma for Hospitalized COVID-19 Patients: A Single-Center Experience

“…to the reduction of mortality for COVID-19 observed during the different waves in our hospital in low-intensity departments (from 21.9% in the first wave to 12.7% in the third wave) in a recently published analysis [ 15 ]. A similar finding, i.e., a strong inverse correlation between CCP use and mortality per hospital admission, was also observed in a recent publication reporting the US experience on EAP use of CCP in approximately 500,000 patients [ 24 ].…”

Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry

“…During the SARS-CoV-2 pandemic, preliminary results from several therapeutic options have raised hopes that subsequent clinical experiences have revealed to be wrong [10] . Moreover, concerning the CCP efficacy, the lack of univocal evidence is probably due to the variety of experimental designs reported in the literature, and even today it is not certain whether it could still give a relevant contribution to the treatment of COVID-19 ( Table 1 ) [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . A randomized controlled trial has been also conducted on 487 patients in Italy, named TSUNAMI Study ( TranSfUsion of coNvalescent plAsma for the treatment of severe pneuMonIa due to SARS-CoV-2 ), under the patronage of the Italian Medicine Agency (AIFA) and the Italian National Institute of Health (ISS), whose definitive results are not yet published.…”

“… [16] UK May 2021 RECOVERY trial, RCT Intervention: 5795 patients, control group: 5,763 patients Moderately/ critically ill patients Among patients hospitalised with COVID-19, high-titre CCP did not improve survival or other prespecified clinical outcomes. Casadevall et al [17] USA June 2021 Retrospective 500,000 patients All clinical conditions CCP use in the USA was inversely correlated with COVID-19 mortality. Körper et al [18] Germany October 2021 Randomized 1:1 Intervention: 53 patients, control group: 52 patients Critically ill patients No significant improvement in CCP treated patients.…”

Convalescent Plasma for Preventing Critical Illness in COVID-19: a Phase 2 Trial and Immune Profile

“…In a randomized trial focusing on inpatient adults with mild disease who were greater than 75 years of age or 65 with comorbid conditions, Libster et al found that CIP was protective of progression to severe disease ( 17 ). Finally, an analysis of CIP usage and mortality across the pandemic showed an inverse correlation, suggesting that CIP saves lives ( 23 ). In contrast, several randomized controlled trials have either terminated early due to low enrollment or found no benefit of CIP ( 13 , 24 – 26 ).…”