Convalescent Plasma Therapy for COVID-19: A Graphical Mosaic of the Worldwide Evidence

Frontiers in Medicine

Sarah E. Baker¹  Stephen A. Klassen¹  Jonathon W. Senefeld¹  Michael J. Joyner¹  Chad C. Wiggins¹  Katherine A. Senese¹  Noud van Helmond²  R. Scott Wright³  Katelyn A. Bruno⁴  DeLisa Fairweather⁴  Nigel S. Paneth⁵  Rickey E. Carter⁶  Patrick W. Johnson⁶  Brenda J. Grossman⁷  Jeffrey P. Henderson⁸  Liise-anne Pirofski⁹  Shmuel Shoham^1,10  Arturo Casadevall^1,10 

[1] Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States;Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, United States;Department of Cardiovascular Medicine, Human Research Protection Program, Mayo Clinic, Rochester, MN, United States;Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States;Department of Epidemiology and Biostatistics, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States;Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States;Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States;Division of Infectious Diseases, Department of Medicine, Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States;Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States;Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States;

关键词: convalescent plasma therapy;    COVID-19;    SARS-CoV-2;    passive antibody transfer;    Kaplan–Meier analysis;   

DOI  :  10.3389/fmed.2021.684151

来源: Frontiers

【 摘 要 】

Convalescent plasma has been used worldwide to treat patients hospitalized with coronavirus disease 2019 (COVID-19) and prevent disease progression. Despite global usage, uncertainty remains regarding plasma efficacy, as randomized controlled trials (RCTs) have provided divergent evidence regarding the survival benefit of convalescent plasma. Here, we argue that during a global health emergency, the mosaic of evidence originating from multiple levels of the epistemic hierarchy should inform contemporary policy and healthcare decisions. Indeed, worldwide matched-control studies have generally found convalescent plasma to improve COVID-19 patient survival, and RCTs have demonstrated a survival benefit when transfused early in the disease course but limited or no benefit later in the disease course when patients required greater supportive therapies. RCTs have also revealed that convalescent plasma transfusion contributes to improved symptomatology and viral clearance. To further investigate the effect of convalescent plasma on patient mortality, we performed a meta-analytical approach to pool daily survival data from all controlled studies that reported Kaplan–Meier survival plots. Qualitative inspection of all available Kaplan–Meier survival data and an aggregate Kaplan–Meier survival plot revealed a directionally consistent pattern among studies arising from multiple levels of the epistemic hierarchy, whereby convalescent plasma transfusion was generally associated with greater patient survival. Given that convalescent plasma has a similar safety profile as standard plasma, convalescent plasma should be implemented within weeks of the onset of future infectious disease outbreaks.

【 授权许可】

CC BY