What is the effect of Convalescent Plasma Therapy(CPT) on clinical outcomes in patients with moderate to severe coronavirus disease 2019 (COVID-19)?
With the dismal results of the PLACID Trial, do we stop using CPT altogether or rationalize its usage more systemically? I strongly feel that measuring the antibody titre in recovered patients and keeping a high index value of neutralising antibodies for acceptance of donors may help us to get optimal results.
I look forward to hearing suggestions from the experts in this field.
Patient selection and timing of convalescent plasma are critical to realizing any potential benefit. SARS-CoV-2 infection is generally a mild self-limiting illness (i.e. mild to moderate COVID-19). Severe and critical COVID-19 generally result from excessive host immune response (hence the benefit of steroids in these patients but not when oxygen is not required). Unless the patient is immunocompromised giving convalescent plasma to patients with severe or critical COVID-19 may actually fuel the fire. Thus I believe the role of convalescent plasma if any is to facilitate clearance of the virus in patients with an immunodeficiency. However if the patient is not immunocompromised the potential risks of convalescent plasma probably outweigh the benefits.
Rajkumar Rajendram sir, thank you for the prompt response. The spectrum of patients that we have encountered in Covid ICU is usually elderly with co-morbidities, including Diabetes Mellitus. In such patients, the use of CPT has shown encouraging results. The younger population (ASA Grade 1 or 2), usually has a self-limited course and does not require aggressive treatment.
Finding from different studies pointed out that CPT has the following uses in SARS‐CoV‐2 patients ;
- It may reduce mortality in critically ill patients
- Increasing neutralizing antibody titers and disappearance of SARS‐CoV‐2 RNA
- Has beneficial effect on clinical symptoms after administration of convalescent plasma.
- Convalescent plasma antibodies can limit the virus reproduction in the acute phase of infection and help clear the virus
NB: the results are non-conclusive and further large scale clinical trials studies are required.
Multiple studies have now reported the use of covid_19 convalescent plasma to treat severly ill patients most of these studies have been observatinal and non randomized complicated by additional therapies such as steroid ,antiviral and other drugs ,patients hetergeniety and lack of detailed analysis of neutralizing antibody content of infused units . So these factors may considered impotent.inspite of lower mortality in patients received convalescent plasma within three days of diagnosis or those who received units of convalescent plasma with higher specific IgG level.
The use of convalescent plasma is one such option has been previously used for treating outbreaks of Ebola, Influenza, middle east respiratory syndrome coronavirus (MERS-CoV)and severe acute respiratory (SAR) viruses.
Among patients with severe or life-threatening COVID-19, convalescent plasma therapy added to standard treatment did not significantly improve the time to clinical improvement within 28 days, although the trial was terminated early and may have been underpowered to detect a clinically important difference.
Convalescent plasma is a potential therapeutic option for patients with coronavirus disease 2019 (COVID-19), but further data from randomized clinical trials are needed.
Primary outcome was time to clinical improvement within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale (ranging from 1 [discharge] to 6 [death]).
Secondary outcomes included 28-day mortality, time to discharge, and the rate of viral polymerase chain reaction (PCR) results turned from positive at baseline to negative at up to 72 hours.
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