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Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks.
Clin Microbiol Infect. 2020 Oct; 26(10):1436-1446.CM

Abstract

BACKGROUND

There is currently no treatment known to alter the course of coronavirus disease 2019 (COVID-19). Convalescent plasma has been used to treat a number of infections during pandemics, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle Eastern respiratory syndrome coronavirus (MERS-CoV) and now severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

OBJECTIVES

To summarize the existing literature and registered clinical trials on the efficacy and safety of convalescent plasma for treating coronaviruses, and discuss issues of feasibility, and donor and patient selection.

SOURCES

A review of articles published in PubMed was performed on 13 July 2020 to summarize the currently available evidence in human studies for convalescent plasma as a treatment for coronaviruses. The World Health Organization International Clinical Trials Registry and clinicaltrials.gov were searched to summarize the currently registered randomized clinical trials for convalescent plasma in COVID-19.

CONTENT

There were sixteen COVID-19, four MERS and five SARS reports describing convalescent plasma use in humans. There were two randomized control trials, both of which were for COVID-19 and were terminated early. Most COVID-19 reports described a potential benefit of convalescent plasma on clinical outcomes in severe or critically ill patients with few immediate adverse events. However, there were a number of limitations, including the concurrent use of antivirals, steroids and other treatments, small sample sizes, lack of randomization or control groups, and short follow-up time. Data from SARS and COVID-19 suggest that earlier administration probably yields better outcomes. The ideal candidates for recipients and donors are not known. Still, experience with previous coronaviruses tells us that antibodies in convalescent patients are probably short-lived. Patients who had more severe disease and who are earlier in their course of recovery may be more likely to have adequate titres. Finally, a number of practical challenges were identified.

IMPLICATIONS

There is currently no effective treatment for COVID-19, and preliminary trials for convalescent plasma suggest that there may be some benefits. However, research to date is at high risk of bias, and randomized control trials are desperately needed to determine the efficacy and safety of this therapeutic option.

Authors+Show Affiliations

Department of Medicine, University of British Columbia, Vancouver, BC, Canada.Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada. Electronic address: hbach@mail.ubc.ca.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32791241

Citation

Wooding, Denise J., and Horacio Bach. "Treatment of COVID-19 With Convalescent Plasma: Lessons From Past Coronavirus Outbreaks." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 26, no. 10, 2020, pp. 1436-1446.
Wooding DJ, Bach H. Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks. Clin Microbiol Infect. 2020;26(10):1436-1446.
Wooding, D. J., & Bach, H. (2020). Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(10), 1436-1446. https://doi.org/10.1016/j.cmi.2020.08.005
Wooding DJ, Bach H. Treatment of COVID-19 With Convalescent Plasma: Lessons From Past Coronavirus Outbreaks. Clin Microbiol Infect. 2020;26(10):1436-1446. PubMed PMID: 32791241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks. AU - Wooding,Denise J, AU - Bach,Horacio, Y1 - 2020/08/11/ PY - 2020/05/17/received PY - 2020/07/18/revised PY - 2020/08/02/accepted PY - 2020/8/14/pubmed PY - 2020/9/30/medline PY - 2020/8/14/entrez KW - COVID-19 KW - Convalescent plasma KW - Coronavirus KW - MERS-CoV KW - SARS-CoV KW - SARS-CoV-2 SP - 1436 EP - 1446 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 26 IS - 10 N2 - BACKGROUND: There is currently no treatment known to alter the course of coronavirus disease 2019 (COVID-19). Convalescent plasma has been used to treat a number of infections during pandemics, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle Eastern respiratory syndrome coronavirus (MERS-CoV) and now severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). OBJECTIVES: To summarize the existing literature and registered clinical trials on the efficacy and safety of convalescent plasma for treating coronaviruses, and discuss issues of feasibility, and donor and patient selection. SOURCES: A review of articles published in PubMed was performed on 13 July 2020 to summarize the currently available evidence in human studies for convalescent plasma as a treatment for coronaviruses. The World Health Organization International Clinical Trials Registry and clinicaltrials.gov were searched to summarize the currently registered randomized clinical trials for convalescent plasma in COVID-19. CONTENT: There were sixteen COVID-19, four MERS and five SARS reports describing convalescent plasma use in humans. There were two randomized control trials, both of which were for COVID-19 and were terminated early. Most COVID-19 reports described a potential benefit of convalescent plasma on clinical outcomes in severe or critically ill patients with few immediate adverse events. However, there were a number of limitations, including the concurrent use of antivirals, steroids and other treatments, small sample sizes, lack of randomization or control groups, and short follow-up time. Data from SARS and COVID-19 suggest that earlier administration probably yields better outcomes. The ideal candidates for recipients and donors are not known. Still, experience with previous coronaviruses tells us that antibodies in convalescent patients are probably short-lived. Patients who had more severe disease and who are earlier in their course of recovery may be more likely to have adequate titres. Finally, a number of practical challenges were identified. IMPLICATIONS: There is currently no effective treatment for COVID-19, and preliminary trials for convalescent plasma suggest that there may be some benefits. However, research to date is at high risk of bias, and randomized control trials are desperately needed to determine the efficacy and safety of this therapeutic option. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/32791241/Treatment_of_COVID_19_with_convalescent_plasma:_lessons_from_past_coronavirus_outbreaks_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(20)30482-1 DB - PRIME DP - Unbound Medicine ER -