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VOLUME 25 , ISSUE 11 ( November, 2021 ) > List of Articles

SYSTEMATIC REVIEW

Convalescent Plasma—A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Soumya Sarkar, Puneet Khanna

Keywords : Convalescent plasma, Coronavirus disease 2019, Meta-analysis, Randomized controlled trial, SARS-CoV-2

Citation Information : Sarkar S, Khanna P. Convalescent Plasma—A Light at the End of the Tunnel: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2021; 25 (11):1292-1300.

DOI: 10.5005/jp-journals-10071-24023

License: CC BY-NC 4.0

Published Online: 16-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

In the absence of a definitive therapy during this ongoing unprecedented crisis, coronavirus disease-2019 (COVID-19) pandemic, convalescent plasma transfusion (CPT) has shown some promising results. This review summarizes the existing evidence of the efficacy of CPT in COVID-19 patients based upon scientific publications to date. We have included only the randomized controlled trials (RCTs) through an extensive screening of electronic databases up to July 31, 2021. In 19 RCTs, with a total of 16,476 COVID-19 patients we found low-quality evidence of significant reduction in mortality (odds ratio (OR) = 0.80; 95% confidence interval (CI): 0.66–0.96, I2 = 40%), better clinical outcome when applied <7 days (OR = 2.13, 95% CI 1.28–3.53, I2 = 0%), and improved viral clearance (OR = 2.6, 95% CI: 1.3–5.45, I2 = 74%). Meta-regression analysis found that as a covariate, intubation on admission (p = 0.007) had a significant impact. However, there was any significant reduction neither in duration for clinical improvement (MD = −0.79, 95% CI: −2.76–1.18, I2 = 98%), nor in total period of hospital stay (MD = 0.02, 95% CI: −0.75–0.78, I2 = 81%). Early application of CPT is still relevant in reducing morbidity and mortality in critically ill patients and is too early to write it off as a potential therapeutic modality for COVID-19 patients.


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  1. Investigational COVID-19 Convalescent Plasma – Emergency INDs [Internet]. U.S. Food and Drug Administration; 2020. Available from: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma.
  2. Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest 2020;130(4):1545–1548. DOI: 10.1172/JCI138003.
  3. Use of convalescent whole blood or plasma collected from patients recovered from Ebola virus disease for transfusion, as an empirical treatment during outbreaks. Geneva: World Health Organization; 2014. Available from: www.who.int/csr/resources/publications/ebola/convalescent-treatment/en [accessed February 16, 2021].
  4. Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Liumbruno GM, et al. Convalescent plasma: new evidence for an old therapeutic tool? Blood Transfus 2016;14(2):152–157. DOI: 10.2450/2015.0131-15.
  5. Luke TC, Kilbane EM, Jackson JL, Hoffman SL. Meta-analysis: convalescent blood products for Spanish influenza pneumonia: a future H5N1 treatment? Ann Intern Med 2006;145(8):599–609. DOI: 10.7326/0003-4819-145-8-200610170-00139.
  6. Soo YO, Cheng Y, Wong R, Hui DS, Lee CK, Tsang KK, et al. Retrospective comparison of convalescent plasma with continuing high-dose methylprednisolone treatment in SARS patients. Clin Microbiol Infect 2004;10(7):676–678. DOI: 10.1111/j.1469-0691.2004.00956.x.
  7. Hung IF, To KK, Lee CK, Lee KL, Chan K, Yan WW, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis 2011;52(4):447–456. DOI: 10.1093/cid/ciq106.
  8. Zhou B, Zhong N, Guan Y. Treatment with convalescent plasma for influenza A (H5N1) infection. N Engl J Med 2007;357(14):1450. DOI: 10.1056/NEJMc070359.
  9. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, Cleary P, Khaw FM, Lim WS, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015;211(1):80–90. DOI: 10.1093/infdis/jiu396.
  10. Sarkar S, Soni KD, Khanna P. Convalescent plasma is a clutch at straws in COVID-19 management! A systematic review and meta-analysis. J Med Virol 2020:10.1002/jmv.26408. DOI: 10.1002/jmv.26408. PMID: 32776573; PMCID: PMC7436491.
  11. Khadka S, Saleem M, Shrestha D, Budhathoki P. Safety and efficacy of convalescent plasma therapy for the management of COVID-19: a systematic review. Aging 2020;13(1):1498–1509. DOI: 10.18632/aging.202195.
  12. Piechotta V, Chai KL, Valk SJ, Doree C, Monsef I, Wood EM, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2020;7(7):CD013600. DOI: 10.1002/14651858.CD013600.pub2. PMID: 32648959; PMCID: PMC7389743.
  13. Devasenapathy N, Ye Z, Loeb M, Fang F, Najafabadi BT, Xiao Y, et al. Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis. CMAJ 2020;192(27):E745. DOI: 10.1503/cmaj.200642.
  14. Shao S, Wang Y, Kang H, Tong Z. Effect of convalescent blood products for patients with severe acute respiratory infections of viral etiology: a systematic review and meta-analysis. Int J Infect Dis 2020:S1201-9712(20)32159-7. DOI: 10.1016/j.ijid.2020.09.1443. PMID: 33002611.
  15. Rajendran K, Krishnasamy N, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID‐19: Systematic review. J Med Virol 2020;92(9):1475–1483. DOI: 10.1002/jmv.25961.
  16. Janiaud P, Axfors C, Schmitt AM, Gloy V, Ebrahimi F, Hepprich M, et al. Association of convalescent plasma treatment with clinical outcomes in patients with COVID-19: a systematic review and meta-analysis. JAMA 2021;325(12):1185–1195. DOI: 10.1001/jama.2021.2747.
  17. Briggs N, Gormally MV, Li F, Browning SL, Treggiari MM, Morrison A, et al. Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19. medRxiv 2021:2021.06.16.21258972. DOI: 10.1101/2021.06.16.21258972.
  18. Fodor E, Müller V, Iványi Z, Berki T, Olga KP, Ambrus M, et al. Early transfusion of convalescent plasma improves the clinical outcome in severe SARS-CoV2 infection. medRxiv 2021:2021.05.25.21257770. DOI: 10.1101/2021.05.25.21257770.
  19. Balcells ME, Rojas L, Le Corre N, Martínez-Valdebenito C, Ceballos ME, Ferrés M, et al. Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: a randomized phase II clinical trial. PLoS Med 2021;18(3):e1003415. DOI: 10.1371/journal.pmed.1003415.
  20. Casadevall A, Dragotakes Q, Johnson PW, Senefeld JW, Klassen SA, Wright RS, et al. Convalescent plasma use in the United States was inversely correlated with COVID-19 mortality: did plasma hesitancy cost lives? medRxiv 2021:2021.04.07.21255089. DOI: 10.1101/2021.04.07.21255089.
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