Usefulness of convalescent plasma transfusion for the treatment of severely ill COVID-19 patients in Pakistan

Abstract

Background Convalescent plasma(CP) was utilized as potential therapy during COVID-19 pandemic in Pakistan. The study aimed at appraisal of CP transfusion safety and usefulness in COVID pneumonia. Methods Single arm, MEURI study design of non-randomized open label trial was conducted in five centers. Patients werecategorized as moderately severe, severe, and critical. The primary endpoint was a) improvement in clinical status and change in category of disease severity; secondary endpoint was b) CP ability to halt disease progression to invasive ventilation. CP transfused to hospitalized patients. Statistical tests including median (interquartile ranges), Mann-Whitney U test, Fisher’s exact test using SPSS ver. 23, ANOVA and Chi-square test were applied for the analysis of results parameters before and after CP treatment. SOFA score was applied for multiorgan failure in severe and critical cases. Results A total of 50 adult patients; median age 58.5 years (range: 29–92 years) received CP with infusion titers; median 1:320 U/mL (Interquartile range 1:80–1:320) between April 4 to May 5, 2020. The median time from onset of symptoms to enrollment in trial was 3 to 7 days with shortness of breath and lung infiltration as severity criterion. In 35 (70%) recipients, oxygen saturation improved from 80 to 95% within 72h, with resolution of lung infiltrates. Primary endpoint was achieved in 44 (88%) recipients whereas secondary endpoint was achieved in 42 (84%). No patient experienced severe adverse events. A high SOFA score (> 7) correlated with deaths in severe and critical patients. Eight (16%) patients expired due to comorbidities; cardiac arrest in 2 (4%), multiorgan failure secondary to cytokine storm in 5 (10%) and ventilator associated complications in 1 (2%). Conclusion CP transfusion can be used as a safe and useful treatment in moderately severe and severe patients. Trial registration The trial registration number is NCT04352751 (https://www.irct.ir/search/result?query=IRCT20200414047072N1). Trial Registration date is 28th April 2020.

Inflammatory markers and auto-Abs to type I IFNs in COVID-19 convalescent plasma cohort study

“… 30 COVID-19 convalescent plasma therapy (CCP) has emerged as a potential treatment for COVID-19, having been studied in a number of clinical trials around the world. 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 The findings of several randomised, controlled clinical trials shed little light on any noteworthy clinical benefits of CCP 32 , 33 , 39 , 41 , 43 , 44 , 45 , 49 , 50 , 58 , 59 while others have reported a favourable outcome, notably when CCP is administered very early after disease onset 60 , 61 and/or in patients with underlying immunodeficiencies. 16 , 44 , 58 , 59 …”

Mortality rates among hospitalized patients with COVID-19 treated with convalescent plasma A Systematic review and meta-analysis

“…In this framework, three matched cohort studies 98,109,114 enrolling 330 participants and 12 case series 54,[134][135][136][137][138][139][140][141][142][143][144] enrolling 29,361 participants were included in this subgroup analysis. In this subgroup meta-analysis, treatment with COVID-19 convalescent plasma containing high antibody levels was associated with a 15% decrease in mortality rates compared to convalescent plasma containing low antibody levels, with a pooled risk ratio estimate of 0.85 (95% CI, 0.73 to 0.99).…”

A comprehensive insight into current control of COVID-19: Immunogenicity, vaccination, and treatment.

“…In addition, the health conditions, age, weight, agreement, and percentages of the recovered donors limited the availability of the convalescent plasms for wide application. Plasma-transfusion considered as safe treatment option and no sever adverse effects were reported [219] . One percent of patients having plasma transfusions may experience febrile and minor allergic reactions in the form of urticaria, which are treated with supportive treatment.…”