Treatment of 5 critically ill patients with COVID-19 with convalescent plasma

Coronavirus disease 2019 ( COVID-19 ) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

The objective of a study was to determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ) infection.

Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome ( ARDS ) who met the following criteria were analysed: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 less than 300; and mechanical ventilation.

All 5 were treated with convalescent plasma transfusion.

The study was conducted at the infectious disease department, Shenzhen Third People's Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020.

Clinical outcomes were compared before and after convalescent plasma transfusion.

Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody ( IgG ) binding titer greater than 1:1000 ( end point dilution titer, by enzyme-linked immunosorbent assay [ ELISA ] ) and a neutralization titer greater than 40 ( end point dilution titer ) that had been obtained from 5 patients who recovered from COVID-19.

Convalescent plasma was administered between 10 and 22 days after admission.

All 5 patients ( age range, 36-65 years; 2 women ) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and Methylprednisolone.

Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days ( range, 172-276 before and 284-366 after ).

Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion ( range, 40-60 before and 80-320 on day 7 ).

ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment.

Of the 5 patients, 3 have been discharged from the hospital ( length of stay: 53, 51, and 55 days ), and 2 are in stable condition at 37 days after transfusion.

In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in clinical status.

The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials. ( Xagena )

Source: JAMA, 2020

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