#VisualAbstract: Progression of COVID-19 reduced after high-titer convalescent plasma administration

1. Majority of the patients that received high-titer convalescent plasma within 72 hours of mild symptom onset were shown to reduce the coronavirus disease 2019 (COVID-19) severe illness progression.

2. The IgG titer distribution between the treatment group and placebo group revealed a significant difference.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The number of deaths, as a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been extremely high among the elderly population. However, studies displaying the use of plasma therapy are limited. This randomized control trial examined the outcome of early high-titer convalescent plasma therapy in older adults with mild COVID-19 symptoms. Patients were randomly assigned to either receive convalescent plasma or a placebo. Patients that received the high-titer plasma therapy displayed a reduction in COVID-19 disease progression. Additionally, the greater number of patients that received the placebo suffered from life-threatening respiratory disease and/or a critical systemic illness. The study was limited by a small number of study participants resulting in a low power value. Moreover, the study data cannot be generalized to all SARS-CoV-2 infected patients, instead can only be applied to elderly patients. Nonetheless, this study’s results are significant, and its findings highlight that high-titer convalescent plasma can reduce the severity of the coronavirus disease.

Click to read the study in NEJM

Relevant Reading: Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19

In-Depth [randomized controlled trial]: This study enrolled 160 patients between June 4, 2020, and October 25, 2020, across hospitals in Argentina. This study enrolled participants who were 75 years of age or older, regardless of any existing comorbidities and patients between the ages of 65 and 74 with at least one or more comorbidities. In order to be eligible, patients had to have at least one sign or symptom of COVID-19. Patients with severe respiratory disease at the time of enrollment were excluded from the study. Patients were randomized in a 1:1 ratio to receive high-titer convalescent plasma or placebo, respectively. Severe respiratory disease was the primary study endpoint which was defined as a high respiratory rate of 30 breaths per minute or more, low oxygen saturation of 92% or less while the patient was on room air or both. Overall, 16% of the patients in the treatment group developed a severe respiratory disease compared to 31% patients in the placebo group (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; P = 0.03). There was a 48% relative risk reduction as a result of administering convalescent plasma. Only 5% of the convalescent group developed life-threatening respiratory disease whereas 12% of the placebo group manifested such a form. Overall, the study showed that early administration of convalescent plasma can be beneficial to elderly patients and can reduce COVID-19 disease progression.

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