The efficiency of convalescent plasma in COVID-19 patients: A systematic review and meta-analysis of randomized controlled clinical trials

Abstract

The objective of this study was to assess whether convalescent plasma therapy could offer survival advantages for patients with novel coronavirus disease 2019 (COVID-19). An electronic search of Pubmed, Web of Science, Embase, Cochrane library and MedRxiv was performed from January 1st, 2020 to April 1st, 2022. We included studies containing patients with COVID-19 and treated with CCP. Data were independently extracted by two reviewers and synthesized with a random-effect analysis model. The primary outcome was 28-d mortality. Secondary outcomes included length of hospital stay, ventilation-free days, 14-d mortality, improvements of symptoms, progression of diseases and requirements of mechanical ventilation. Safety outcomes included the incidence of all adverse events (AEs) and serious adverse events (SAEs). The Cochrane risk-of-bias assessment tool 2.0 was used to assess the potential risk of bias in eligible studies. The heterogeneity of results was assessed by I^2 test and Q statistic test. The possibility of publication bias was assessed by conducting Begg and Egger test. GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used for quality of evidence. This study had been registered on PROSPERO, CRD42021273608. 32 RCTs comprising 21478 patients with Covid-19 were included. Compared to the control group, COVID-19 patients receiving CCP were not associated with significantly reduced 28-d mortality (CCP 20.0% vs control 20.8%; risk ratio 0.94; 95% CI 0.87-1.02; p = 0.16; I² = 8%). For all secondary outcomes, there were no significant differences between CCP group and control group. The incidence of AEs (26.9% vs 19.4%,; risk ratio 1.14; 95% CI 0.99-01.31; p = 0.06; I² = 38%) and SAEs (16.3% vs 13.5%; risk ratio 1.03; 95% CI 0.87-1.20; p = 0.76; I² = 42%) tended to be higher in the CCP group compared to the control group, while the differences did not reach statistical significance. In all, CCP therapy was not related to significantly improved 28-d mortality or symptoms recovery, and should not be viewed as a routine treatment for COVID-19 patients.Trial registration numberCRD42021273608. Registration on February 28, 2022Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, Identifier CRD42022313265.

Zum Stellenwert von Rekonvaleszentenplasma bei der Therapie von COVID-19

“…Eine aktuelle Metaanalyse, in der 32 randomisierten Studien mit insgesamt 21478 behandelten Patienten berücksichtigt sind, gibt für die unselektierte Gesamtgruppe der CCP-behandelten Patienten eine Risikoratio für die Tag-28-Mortalität von 0,94 (95 % Konfidenzintervall: 0,87-1,02) an [4]. Studien, die eine späte CCP-Transfusion im Krankheitsverlauf bei unselektierten Patienten untersuchten, konnten in der Mehrzahl keine Wirksamkeit nachweisen [1,4]. In randomisierten und nicht randomisierten Studien zeigen sich Signale für die Wirksamkeit bei Patienten, welche mit einer hohen, kumulativen anti-SARS-CoV-2-Antikörpermenge behandelt werden (z.…”

Facing the Challenges in the COVID-19 Pandemic Era: From Standard Treatments to the Umbilical Cord-Derived Mesenchymal Stromal Cells as a New Therapeutic Strategy

“…Even if it was seen as a promising strategy, the administration of plasma from convalescent patients, the hyperimmune plasma, did not exert any significant reduction in mortality and had minor impact on clinical improvement in individuals with moderate to severe disease [ 79 ]. A Chinese meta-analysis study [ 80 ] described that, in 32 randomized controlled trials and 21,478 patients, convalescent plasma therapy was not associated with significantly reduced 28-day mortality in COVID-19 patients, and it was not related to improvements in other survival outcomes (length of hospitalization, time without respiratory support, risk of symptoms progression, and requirement of mechanical ventilation). Moreover, in terms of safety, the treatment presented a trend with no statistical significance of higher incidence of adverse events, suggesting that the treatment could be recommended only in the context of clinical trials for severe COVID-19 patients, due to limited suppressive effect on inflammation and no significantly improved clinical outcomes [ 80 ].…”

COVID-19 Seroprevalence in a Mixed Cohort of SARS-CoV-2 PCR Positive and Exposed Subjects

“…It was also postulated that these patients could be potential donors of convalescent plasma, which was theorized to be a life-saving therapy. Unfortunately, meta-analyses have shown that convalescent plasma is not an optimal treatment choice for COVID-19 [5,6].…”