April 16, 2020
Convalescent Plasma Therapy in Patients with Severe COVID-19
Anthony L. Komaroff, MD reviewing
A preliminary report on 10 Chinese patients suggests benefit.
Immunotherapy with neutralizing antibodies present in convalescent plasma (CP) proved to be effective and safe for patients with SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and the 2009 H1N1 influenza viruses. To test whether CP would benefit COVID-19 patients as well, researchers in Wuhan, China, performed a study in 10 severely ill COVID-19 patients who also received many different antivirals. Median age of the patients was 53, 4 had chronic illnesses, and 3 were on ventilators.
Within 3 days of CP therapy, most patients exhibited improved clinical symptoms, higher levels of blood oxygen and lymphocytes, lower C-reactive protein levels, undetectable viral loads, and improved chest computed tomography scans; two patients were weaned from ventilators. Treatment was particularly successful if CP was given within 14 days of symptom onset; no adverse effects were noted. The investigators assembled a historical control group of 10 COVID-19 patients in the same hospitals and of the same age, sex, and disease severity. Of the 10 CP-treated patients, 3 were discharged and 7 were much improved, whereas in the control group, 3 patients died, 6 were stable, and 1 improved.
COMMENT
This small series provides some encouragement that convalescent plasma (CP) therapy might be effective and safe for severely ill COVID-19 patients, particularly if it is started within the first 14 days of symptom onset. These results back up smaller uncontrolled case studies (e.g., NEJM JW Infect Dis Jun 2020 and JAMA 2020 Mar 27; [e-pub]). If further studies confirm that CP is beneficial, can enough CP be collected to make a substantial difference in an epidemic of this magnitude? That remains to be seen.
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