Safety and efficacy of convalescent plasma for severe COVID-19: a randomized, single blinded, parallel, controlled clinical study

Manuel Rojas, Yhojan Rodríguez, Juan Carlos Hernández, Juan C. Díaz-Coronado, José Alejandro Daza Vergara, Verónica Posada Vélez, Jessica Porras Mancilla, Iván Araujo, Jairo Torres Yepes, Oscar Briceño Ricaurte, Juan Mauricio Pardo-Oviedo, Diana M. Monsalve, Yeny Acosta-Ampudia, Carolina Ramírez-Santana, Paula Gaviria García, Lina Acevedo Landinez, Luisa Duarte Correales, Jeser Santiago Grass, Cristian Ricaurte Pérez, Gustavo Salguero LópezNataly Mateus, Laura Mancera, Ronald Rengifo Devia, Juan Esteban Orjuela, Christian R. Parra-Moreno, Andrés Alfonso Buitrago, Inés Elvira Ordoñez, Claudia Fabra Osorio, Nathalia Ballesteros, Luz H. Patiño, Sergio Castañeda, Marina Muñoz, Juan David Ramírez, Paul Bastard, Adrian Gervais, Lucy Bizien, Jean Laurent Casanova, Bernardo Camacho, Juan Esteban Gallo, Oscar Gómez, Adriana Rojas-Villarraga, Carlos E. Pérez, Rubén Manrique, Rubén D. Mantilla, Juan Manuel Anaya

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Abstract

Background: Convalescent plasma (CP) has been widely used to treat COVID-19 and is under study. However, the variability in the current clinical trials has averted its wide use in the current pandemic. We aimed to evaluate the safety and efficacy of CP in severe coronavirus disease 2019 (COVID-19) in the early stages of the disease. Methods: A randomized controlled clinical study was conducted on 101 patients admitted to the hospital with confirmed severe COVID-19. Most participants had less than 14 days from symptoms onset and less than seven days from hospitalization. Fifty patients were assigned to receive CP plus standard therapy (ST), and 51 were assigned to receive ST alone. Participants in the CP arm received two doses of 250 mL each, transfused 24 h apart. All transfused plasma was obtained from "super donors" that fulfilled the following criteria: titers of anti-SARS-CoV-2 S1 IgG ≥ 1:3200 and IgA ≥ 1:800 antibodies. The effect of transfused anti-IFN antibodies and the SARS-CoV-2 variants at the entry of the study on the overall CP efficacy was evaluated. The primary outcomes were the reduction in viral load and the increase in IgG and IgA antibodies at 28 days of follow-up. The per-protocol analysis included 91 patients. Results: An early but transient increase in IgG anti-S1-SARS-CoV-2 antibody levels at day 4 post-transfusion was observed (Estimated difference [ED], − 1.36; 95% CI, − 2.33 to − 0.39; P = 0.04). However, CP was not associated with viral load reduction in any of the points evaluated. Analysis of secondary outcomes revealed that those patients in the CP arm disclosed a shorter time to discharge (ED adjusted for mortality, 3.1 days; 95% CI, 0.20 to 5.94; P = 0.0361) or a reduction of 2 points on the WHO scale when compared with the ST group (HR adjusted for mortality, 1.6; 95% CI, 1.03 to 2.5; P = 0.0376). There were no benefits from CP on the rates of intensive care unit admission (HR, 0.82; 95% CI, 0.35 to 1.9; P = 0.6399), mechanical ventilation (HR, 0.66; 95% CI, 0.25 to 1.7; P = 0.4039), or mortality (HR, 3.2; 95% CI, 0.64 to 16; P = 0.1584). Anti-IFN antibodies and SARS-CoV-2 variants did not influence these results. Conclusion: CP was not associated with viral load reduction, despite the early increase in IgG anti-SARS-CoV-2 antibodies. However, CP is safe and could be a therapeutic option to reduce the hospital length of stay.

Original languageEnglish
Article number575
JournalBMC Infectious Diseases
Volume22
Issue number1
DOIs
StatePublished - Dec 2022

Keywords

  • Clinical trial
  • Convalescent plasma
  • COVID-19
  • SARS-CoV-2

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