“PLEXIT - Therapeutic plasma exchange (TPE) for Covid-19 cytokine release storm (CRS), a retrospective propensity matched control study”

Abstract

Importance: Cytokine release storm (CRS) plays pivotal role in pathophysiology and progression of COVID-19. Objective: To evaluate the outcomes of COVID-19 patients having CRS treated with Therapeutic Plasma Exchange (TPE) as compared to controls not receiving TPE. Design: Retrospective propensity score (PS) matched analysis, 1st April to 30th June 2020. Setting: Tertiary care hospital, single centre based. Participants: Using PS 1:1 matching, 90 patients were assigned 2 groups (45 receiving TPE and 45 controls). Forced matching and covariate matching was done to overcome bias between two groups. Main outcomes and measures: Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of PCR negativity. Results: Median age was 60 years (range 32-73 in TPE, 37-75 in non-TPE group), p= 0.325. Median symptoms duration 7 days (range 3-22 days TPE and 3-20 days non-TPE), p=0.266. Disease severity in both groups was 6.6% moderate, 44.4% severe and 49% critical. Twenty-eight-day survival was significantly superior in TPE group (91.1%) as compared to controls (61.5%), HR 0.21, 95% CI for HR 0.09-0.53, log rank 0.002. Median duration of hospitalization was significantly reduced in TPE treated group as compared to non-TPE controls 10 days and 15 days respectively (p< 0.01). CRS resolution time was also significantly reduced in TPE treated group (6 days vs. 12 days) (p< 0.001). Conclusion and Relevance: Use of TPE is associated with superior overall survival, early CRS resolution and time to discharge as compared to standard therapy for COVID-19 triggered CRS.

Efectiveness of Therapeutic Plasma Exchange in Patients Suffering from COVID-19 Requiring Admission in Critical Care Setting

“…They came up with the conclusion that the use of therapeutic plasma exchange was associated with superior overall survival, early cytokine release syndrome resolution, and time to discharge as compared to standard therapy for COVID-19. 16 Our results supported their findings. There was a strong statistically significant relationship with lesser mortality and use of TPE among patients of COVID-19 admitted in the Critical Care Unit.…”

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

“…Further, 3 retrospective, observational cohort studies including a total of 74 patients treated with plasmapheresis have reported dramatic differences in both extubation and survival. 104,196,197 The largest, a study from Pakistan of 45 COVID-19 patients treated with plasmapheresis compared to 45 propensity matched controls, reported that the mortality in the plasmapheresis treated group was 8.9% vs 38.5% in controls, HR 0.21, 95% CI 0.09-0.53, log rank .002. 197 Khamis et al in Oman published on 31 COVID-19 patients in moderate to severe respiratory failure where 11 of the more severely ill patients received TPE with a slightly higher proportion of the TPE group also receiving tocilizumab compared to controls.…”

Attenuation of age-elevated blood factors by repositioning plasmapheresis: A novel perspective and approach

“…These findings suggest that TPE, especially along with convalescent plasma infusion at the end of the procedure, can be an effective treatment for COVID-19 [53]. A randomized controlled clinical trial recently demonstrated that TPE is an effective treatment for COVID-19 [55]. Other specific targets of TPE include highly charged proteins identified as having a high probability of losing stability due to oxidation with age.…”