The feasibility of convalescent plasma therapy in severe COVID- 19 patients: a pilot study

Abstract

Currently, there are no approved specific antiviral agents for 2019 novel coronavirus disease . In this study, ten severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 days after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 days. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 days. Several parameters tended to improve as compared to pre-transfusion, including increased lymphocyte counts (0.65×10 9 /L vs. 0.76×10 9 /L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesionswithin 7 days. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was welltolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in larger well-controlled trials. Significance StatementCOVID-19is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explored the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was welltolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 days. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 days. Radiological examination All rights reserved. No reuse allowed without permission.

Deployment of convalescent plasma for the prevention and treatment of COVID-19

“…While data are limited, seroconversion has been observed to occur between 8 and 21 days after the onset of symptoms (28,30). Coupled with reports from China of high titers of anti-SARS-CoV-2 antibodies in the overwhelming majority of convalescent patients, the findings suggest that units of plasma that are collected ≥14 days after resolution of symptoms should contain high titers of antibodies (22). In the setting of a temporizing therapy, one needs to balance acuity of need with a desire for a highly validated assay and a refined treatment modality.…”

“…In this current pandemic, there are reports that convalescent plasma has been used in China to treat patients with COVID- 19 (20, 21). In a pilot study of 10 patients with severe COVID-19, the investigators collected convalescent plasma with neutralizing antibody titers at or exceeding a 1:640 dilution (22). Transfusion of convalescent plasma resulted in no serious adverse effect in the recipients.…”

“…prevention versus treatment). Pertinent to the current pandemic, a study in China, employed a single (200 mL) unit of plasma (22). In the planned clinical trials, one unit has been proposed for use for post-exposure prophylaxis and one to two units have been proposed for treatment.…”

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients With COVID-19 (April 2020)

“…[36,37]. All five patients in Shen 2020 were mechanically ventilated at time of treatment compared with three out of 10 patients in the Duan et al study.…”

Intervention Serology and Interaction Substitution: Modeling the Role of ‘Shield Immunity’ in Reducing COVID-19 Epidemic Spread

“…We show that a shield immunity approach may significantly reduce the length and reduce the overall burden of an outbreak, and can work synergistically with social distancing. The present model highlights the value of serological testing as part of intervention strategies, in addition to its well recognized roles in estimating prevalence [10,11] and in the potential development of plasma-based therapies [12][13][14][15].In the absence of reliable pharmaceutical interventions against SARS-CoV-2, multiple public health strategies are being deployed to slow the coronavirus pandemic [1,5,16]. These strategies can be broadly grouped into two approaches: mitigation; and suppression.…”