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In the search for an effective approach to manage COVID-19, researchers in China evaluated the administration of convalescent plasma to five critically ill patients (age range, 36–73). All recipients were mechanically ventilated and had been on steroids and at least two of the following agents: lopinavir/ritonavir, interferon alfa-1b, favipiravir, arbidol, and darunavir. Between 10 and 22 days after hospital admission, each patient received two infusions of plasma (total volume, 400 mL) from donors who had recently recovered from COVID-19. Receptor-binding–specific antibodies and neutralizing antibody titers of donors and recipients were comparable prior to infusion.
Between 2 and 9 days after infusion, three patients were extubated (with discharge after hospital stays ranging from 51 to 55 days). Two patients remained intubated and in stable condition (length of hospital stay since infusion, 37 days). The inflammatory markers IL-6, C-reactive protein, and procalcitonin declined in four patients; in the fifth patient, two of the three markers declined. Viremia had cleared in all five patients by 1 to 12 days postinfusion.
Shen C et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA 2020 Mar 27; [e-pub]. (https://doi.org/10.1001/jama.2020.4783)
Roback JD and Guarner J.Convalescent plasma to treat COVID-19: Possibilities and challenges. JAMA 2020 Mar 27; [e-pub]. (https://doi.org/10.1001/jama.2020.4940)
Comment
This small case series points to the potential use of convalescent plasma for management of COVID-19, which is currently approved by the FDA under an emergency investigational new drug protocol. Notably, the study was uncontrolled, and while three of the five patients were discharged, their duration of hospital stay was >50 days (and the remaining two recipients remained intubated at publication). Editorialists note the need to generate rigorous, controlled, randomized data on the safety and effectiveness of convalescent plasma for COVID-19 management and to chart a path for applying and disseminating the approach. Critical elements include mobilizing blood centers to collect convalescent plasma, initiating transfusions early in the illness course (before the development of antibodies), and guiding the distribution of plasma to areas of greatest need.