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From COVID-19's earliest days, patients have been treated with plasma from individuals who have recovered from their infections (convalescent plasma; CP). Still, it remains unclear whether this therapy improves outcomes. Investigators in the U.K. randomized 11,558 hospitalized participants in the RECOVERY trial to receive open-label, high-titer CP plus usual care or usual care alone. Median time from symptom onset to randomization was 9 days. Regarding disease severity at enrollment, 87% of participants required oxygen only, 5% were receiving invasive mechanical ventilation (IMV), and 8% did not need any supplemental oxygen. Use of other therapies, such as corticosteroids and remdesivir, was balanced between the two groups.
Mortality at 28 days was 24% in both the CP and usual care groups. Time to discharge, probability of being discharged alive, and number of patients progressing to IMV or death were similar in both groups. Among participants negative for anti–SARS-CoV-2 antibodies at baseline, mortality was comparable in the CP and usual care groups (32% and 34%, respectively).
RECOVERY Collaborative Group.Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): A randomised controlled, open-label, platform trial. Lancet 2021 May 29; 397:2049. (https://doi.org/10.1016/S0140-6736(21)00897-7)
Comment
As this large, randomized trial does not demonstrate a survival benefit of CP in hospitalized patients with COVID-19, the findings should steer us away from such treatment in this setting. However, the study does not answer whether convalescent plasma would improve outcomes among high-risk patients earlier in the course of their disease (as suggested in a different study; NEJM JW Infect Dis Mar 2021 and N Engl J Med 2021 Jan 6; [e-pub]) or in highly immunosuppressed patients with persistent SARS-CoV-2 replication. Those important patient populations require evaluation in future studies.