Effectiveness of convalescent plasma therapy in severe COVID-19 patients

By Kai Duan, Bende Liu, Cesheng Li, Huajun Zhang, Ting Yu, J. Qu, Min Zhou, Li Chen, S. Meng, Yong Hu and 38 more. Proceedings of the National Academy of Sciences of the United States of America, 2020

1,797 citations recorded by the source corpus.

Significance COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted. Currently, there are no approved specific antiviral agents for novel coronavirus disease 2019 (COVID-19). In this study, 10 severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 d after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 d. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 d. Several parameters tended to improve as compared to pretransfusion, including increased lymphocyte counts (0.65 × 109/L vs. 0.76 × 109/L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesions within 7 d. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in larger well-controlled trials.

Subfields: Infectious Diseases, Neurology

View Paper: https://www.semanticscholar.org/paper/bda730984d78d20baecc01f01820acbeac47bfe5

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In Infectious Diseases

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Citations in the corpus

• Autopsy Findings and Venous Thromboembolism in Patients With COVID-19 (2020, background): “Clearance of viral RNA from blood 7 days after transfusion of COVID-19 convalescent plasma was associated with substantial clinical improvement, but studies have not shown a correlation between viremia and acute respiratory distress syndrome in patients with severe COVID-19 (28, 29).”
• Protocol and Reagents for Pseudotyping Lentiviral Particles with SARS-CoV-2 Spike Protein for Neutralization Assays (2020, background): “This assay allows human sera or plasma samples to be screened in a convenient 96-well format, which will help facilitate the testing of large numbers of patient samples to better understand the development of immunity and to potentially screen donors for passive transfer of convalescent plasma [25,5”
• Insights into SARS-CoV-2 genome, structure, evolution, pathogenesis and therapies: Structural genomics approach (2020, neutral): “During the time of the COVID-19 pandemic, the successful application of this therapy is effective in some of the patients [149].”
• Mapping Neutralizing and Immunodominant Sites on the SARS-CoV-2 Spike Receptor-Binding Domain by Structure-Guided High-Resolution Serology (2020, neutral): “Recent small-scale studies suggest that treatment of COVID-19 patients with convalescent plasma improved clinical outcomes and decreased viral loads (Duan et al., 2020; Li et al., 2020a; Liu et al., 2020b; Shen et al., 2020), highlighting the importance transfer of potently neutralizing human…”
• Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. (2020, background): “6) Interval between symptom onset and admission, median (IQR), d 12 (5-20) [n = 49] 10 (6-16) [n = 48]”