SARS-CoV-2 antibody changes in patients receiving COVID-19 convalescent plasma from normal and vaccinated donors

Leon, Judith; Merrill, Anna E.; Rogers, Kai J.; Kurt, Julie; Dempewolf, Spencer; Ehlers, Alexandra; Jackson, J. Brooks; Knudson, C. Michael

doi:10.1016/j.transci.2021.103326

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Moreover, our study did not explore using VaxPlasma (hybrid plasma) obtained from vaccinated donors, which contains antibodies with 10 times higher titers than standard high-titer CCP and has shown high effectiveness against the omicron variant. Although some CCP donors in our study may have received inactivated or ChAdOx-1 nCoV vaccinations, we could not clarify their impact ( 42 , 54 – 56 ).…”

Section: Discussionmentioning

confidence: 96%

Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab)

Siripongboonsitti,

Nontawong,

Tawinprai

et al. 2023

Microbiol Spectr

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The effectiveness of neutralizing monoclonal antibodies against emerging variants with spike protein mutations has been limited. Early high-titer convalescent plasma therapy (CPT) tends to be effective and a potential treatment option for COVID-19 outpatient treatment. An open-label, 1:1, randomized controlled trial compared the efficacy of high neutralizing titer CPT with favipiravir (CPT-FPV) versus sotrovimab. The study aimed to evaluate the non-inferiority of CPT-FPV treatment compared to sotrovimab in preventing hospitalization within 14 and 28 days. Among the 136 randomized participants, 68 received CPT-FPV, while 68 received sotrovimab. The study demonstrated that CPT-FPV was non-inferior to sotrovimab in preventing hospitalization within 14 and 28 days. No significant differences between the two treatment arms were observed in emergency room visits, oxygen supplementation, or mortality. Although there were no significant disparities in radiological, virological, or inflammatory marker outcomes, sotrovimab exhibited a more pronounced reduction in IL-6 levels during days 2–5 and lower MCP-1 levels on day 14. High neutralizing titer convalescent plasma and favipiravir demonstrated non-inferior to sotrovimab in preventing hospitalization, emergency room visit, oxygen supplementation, and mortality in mild-to-moderate COVID-19. The evidence may be a choice for treatment for new variants despite the need for further study. (The trial protocol was registered in the Thai clinical trials registry no. 20220319002.) IMPORTANCE This pivotal study reveals that high neutralizing titer COVID-19 convalescent plasma therapy (CPT) combined with favipiravir (FPV) is non-inferior to sotrovimab in preventing hospitalization and severe outcomes in outpatients with mild-to-moderate COVID-19 and high-risk comorbidities. It underscores the potential of CPT-FPV as a viable alternative to neutralizing monoclonal antibodies like sotrovimab, especially amid emerging variants with spike protein mutations. The study’s unique approach, comparing a monoclonal antibody with CPT, demonstrates the efficacy of early intervention using high neutralizing antibody titer CPT, even in populations with a significant proportion of elderly patients. These findings are crucial, considering the alternative treatment challenges, especially in resource-limited countries, posed by the rapidly mutating SARS-CoV-2 virus and the need for adaptable therapeutic strategies.

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Section: Discussionmentioning

confidence: 96%

Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab)

Siripongboonsitti,

Nontawong,

Tawinprai

et al. 2023

Microbiol Spectr

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“…Antibody levels in those who have both been vaccinated and recovered from COVID-19 have high levels of neutralization ability including against Omicron variants. 50 , 51 , 52 , 53 …”

Section: Prevention Of Infectionsmentioning

confidence: 99%

Vaccines and therapeutics for immunocompromised patients with COVID-19

Shoham¹,

Batista²,

Amor³

et al. 2023

eClinicalMedicine

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“…Most studies—independent of immune status—pertain to acute COVID-19 in which a dose of 1–2 units of CCP (200–300 mL per unit) has been used; that dose was based on experience with convalescent plasma prior to the COVID-19 pandemic [ 1 ]. Two units are more likely to result in detectable antibodies in the recipient than 1 unit alone [ 30 ].…”

Section: Dosage Timing and Duration Depend On The Indication ...mentioning

confidence: 99%

“…The CCP collected from individuals who have been vaccinated and recovered from natural COVID-19 [so called “VaxPlasma” or “hybrid plasma”] has 10-times greater titers of antibodies (potentially delivering more antibody neutralization with similar or less volume) against SARS-CoV-2 than standard high-titer CCP [ 30 , 34 , 35 ], upon which initial authorizations of CCP were granted. Moreover, “VaxPlasma” is highly effective against Omicron variants, unlike most mAbs, which have been shown to be ineffective [ 35–37 ].…”

Section: Dosage Timing and Duration Depend On The Indication ...mentioning

confidence: 99%

Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019

Bloch

Focosi²,

Shoham

et al. 2023

Clinical Infectious Diseases

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COVID-19 convalescent plasma (CCP) is a safe and effective treatment for COVID-19 in immune compromised (IC) patients. IC patients have a higher risk of persistent infection, severe disease and death from COVID-19. Despite the continued clinical use of CCP to treat IC patients, the optimal dose, frequency/schedule, and duration of CCP treatment has yet to be determined, and related best practices guidelines are lacking. A group of individuals with expertise spanning infectious diseases, virology and transfusion medicine was assembled to render an expert opinion statement pertaining to the use of CCP for IC patients. For optimal effect, CCP should be recently and locally collected to match circulating variant. CCP should be considered for the treatment of IC patients with acute and protracted COVID-19; dosage depends on clinical setting (acute vs protracted COVID-19). CCP containing high-titer SARS-CoV-2 antibodies, retains activity against circulating SARS-CoV-2 variants, which have otherwise rendered monoclonal antibodies ineffective.

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SARS-CoV-2 antibody changes in patients receiving COVID-19 convalescent plasma from normal and vaccinated donors

Cited by 12 publications

References 23 publications

Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab)

Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab)

Vaccines and therapeutics for immunocompromised patients with COVID-19

Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019

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