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Convalescent Plasma Treatment of Patients Previously Treated with B-Cell-Depleting Monoclonal Antibodies Suffering COVID-19 Is Associated with Reduced Re-Admission Rates. Viruses 2023; 15:v15030756. [PMID: 36992465 PMCID: PMC10059055 DOI: 10.3390/v15030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Patients receiving treatment with B-cell-depleting monoclonal antibodies, such as anti-CD20 monoclonal antibodies, such as rituximab and obinutuzumab, either for hematological disease or another diagnosis, such as a rheumatological disease, are at an increased risk for medical complications and mortality from COVID-19. Since inconsistencies persist regarding the use of convalescent plasma (CP), especially in the vulnerable patient population that has received previous treatment with B-cell-depleting monoclonal antibodies, further studies should be performed in thisdirection. The aim of the present study was to describe the characteristics of patients with previous use of B-cell-depleting monoclonal antibodies and describe the potential beneficial effects of CP use in terms of mortality, ICU admission and disease relapse. In this retrospective cohort study, 39 patients with previous use of B-cell-depleting monoclonal antibodies hospitalized in the COVID-19 department of a tertiary hospital in Greece were recorded and evaluated. The mean age was 66.3 years and 51.3% were male. Regarding treatment for COVID-19, remdesivir was used in 89.7%, corticosteroids in 94.9% and CP in 53.8%. In-hospital mortality was 15.4%. Patients who died were more likely to need ICU admission and also had a trend towards a longer hospital stay, even though the last did not reach statistical significance. Patients treated with CP had a lower re-admission rate for COVID-19 after discharge. Further studies should be performed to identify the role of CP in patients with treatment with B-cell-depleting monoclonal antibodies suffering from COVID-19.
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2
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Alkhalifa H, Alsalman Z, Alfaraj A, Algaraash M, Alsalman M. Thrombocytopenia and clinical outcomes among patients with COVID-19 disease: A cohort study. Health Sci Rep 2023; 6:e1111. [PMID: 36794125 PMCID: PMC9923718 DOI: 10.1002/hsr2.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Background and Aims Thrombocytopenia is increasingly recognized among patients with critical illness and plays a role in several diseases affecting different organ systems. Therefore, we studied the prevalence of thrombocytopenia among hospitalized COVID-19 patients and its correlation with disease severity and clinical outcomes. Methods This was an observational retrospective cohort study conducted on 256 hospitalized COVID-19 patients. Thrombocytopenia is defined as a platelet count below 150,000/μL. Disease severity was classified based on the five-point CXR scoring tool. Results Thrombocytopenia was found in 66 (25.78%) patients. In outcomes, 41 (16%) patients were admitted to intensive care unit, 51 (19.9%) died, and 50 (19.5%) had acute kidney injury (AKI). Of the total patients with thrombocytopenia, 58 (87.9%) had early thrombocytopenia, while 8 (12.1%) had late thrombocytopenia. Notably, mean survival time was markedly decreased in late-onset thrombocytopenia cases (p < 0.0001). Patients with thrombocytopenia showed a significant increase in creatinine compared to those with normal platelet counts (p < 0.05). Moreover, thrombocytopenia was more prevalent in patients with chronic kidney disease compared to other comorbidities (p < 0.05). In addition, hemoglobin was significantly lower in the thrombocytopenia group (p < 0.05). Conclusion Thrombocytopenia is a common finding among COVID-19 patients, with a predilection toward a specific group of patients, though the exact reasons are unclear. It predicts poor clinical outcomes and is closely linked to mortality, AKI, and the need for mechanical ventilation. These findings suggest that more research is required to study the mechanism of thrombocytopenia and the possibility of thrombotic microangiopathy in COVID-19 patients.
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Affiliation(s)
- Hussain Alkhalifa
- Department of Medicine, College of MedicineKing Faisal UniversitySaudi Arabia
| | - Zaenb Alsalman
- Department of Family and Community Medicine, College of MedicineKing Faisal UniversitySaudi Arabia
| | - Aman Alfaraj
- Department of MedicineKing Fahad Specialist HospitalDammamSaudi Arabia
| | | | - Mortadah Alsalman
- Department of Medicine, College of MedicineKing Faisal UniversitySaudi Arabia
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3
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Lanza F, Monaco F, Ciceri F, Cairoli R, Sacchi MV, Guidetti A, Marchetti M, Massaia M, Arcaini L, Krampera M, Mohamed S, Gherlinzoni F, Mecucci C, Gentile M, Romano I, Venditti A, Ruggeri M, Ferrero D, Coviello E, Fabbri E, Corradini P, Passamonti F. Lack of efficacy of convalescent plasma in COVID-19 patients with concomitant hematological malignancies: An Italian retrospective study. Hematol Oncol 2022; 40:857-863. [PMID: 35932208 PMCID: PMC9538413 DOI: 10.1002/hon.3060] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 12/13/2022]
Abstract
A multicenter retrospective study was designed to assess clinical outcome of COVID-19 in patients with hematological malignancies (HM) following treatment with anti-SARS-CoV-2 convalescent plasma (CP) or standard of care therapy. To this aim, a propensity score matching was used to assess the role of non-randomized administration of CP in this high-risk cohort of patients from the Italian Hematology Alliance on COVID-19 (ITA-HEMA-COV) project, now including 2049 untreated control patients. We investigated 30- and 90-day mortality, rate of admission to intensive care unit, proportion of patients requiring mechanical ventilatory support, hospitalization time, and SARS-CoV-2 clearance in 79 CP recipients and compared results with 158 propensity score-matched controls. Results indicated a lack of efficacy of CP in the study group compared with the untreated group, thus confirming the negative results obtained from randomized studies in immunocompetent individuals with COVID-19. In conclusion, this retrospective analysis did not meet the primary and secondary end points in any category of immunocompromized patients affected by HM.
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Affiliation(s)
| | | | - Fabio Ciceri
- IRCCS Ospedale San RaffaeleUniversity Vita‐Salute San RaffaeleMilanoItaly
| | | | - Maria Vittoria Sacchi
- Hematology Unit, SCDU Ematologia ‐ Az Ospedaliera Santi Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Monia Marchetti
- Hematology Unit, SCDU Ematologia ‐ Az Ospedaliera Santi Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | | - Sara Mohamed
- Hematology UnitAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | | | | | | | | | - Adriano Venditti
- Hematology, Department of Biomedicine and PreventionUniversity Tor VergataRomaItaly
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4
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Seghatchian J, Pereira P, Lanza F. Spotlights on the latest opinions on identification, prevention, and management of newer CoV-2 variants: A roundup appraisal on innovative ideas and designer vaccines for Omicron. Transfus Apher Sci 2022; 61:103499. [PMID: 35811273 PMCID: PMC9250817 DOI: 10.1016/j.transci.2022.103499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/02/2022] [Accepted: 06/30/2022] [Indexed: 10/24/2022]
Abstract
Although mass vaccination combined with some other preventative strategies and lockdown was associated with some early signs that COVID-19 infection might be fading away, the over 35 sites mutated new South African variant, "Omicron", emerged almost globally. Certain predisposed hosts may develop severe inflammatory thrombotic or mild long-Covid conditions due to this variant, which depletes T-cells, neutralizes antibodies circulating in the body, and coincidentally induces hypercoagulability. The surge of Omicron combined with Delta variants may confer unresponsiveness to the currently available vaccines even when the second dose is given up to 90 days. A drop in the antibody levels by 30 % has been identified in omicron-infected individuals, and one in five people is resistant to antibody treatment. This poses major concerns in the transmissibility rate of this new variant, even in a heavy mass vaccinated environment. This heavily mutated Omicron with other spike sites facilitates viral entry into the cells through conformational changes, irrespective of circulating neutralising antibody. Based on this consideration, we believe that speeding up mixed-matched vaccines with higher T-cell stimulation ability may improve the current situation. Moreover, large orders for antiviral drugs and monoclonal antibodies that could tackle Omicron combined with other variants may be valuable. The use of free polyclonal antibody donations and, hopefully, T-cell immunotherapy, may represent further breakthrough therapeutic interventions. However, Omicron infection is relatively milder than the ongoing Delta variant but is extremely contagious, and therefore the development of novel interventions is highly demanding.
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Affiliation(s)
- Jerard Seghatchian
- International Consultancy in Innovative Manufacturing and Quality/Safety of Blood-Derived Bioproducts. London, England, UK
| | - Paulo Pereira
- Portuguese Institute of Blood and Transplantation, Lisbon, Portugal
| | - Francesco Lanza
- Hematology Unit & Romagna Transplant Network, Ravenna, Italy.
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5
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Agrawal A, Jha T, Gogoi P, Diwaker P, Goel A, Khan AM, Saxena AK. Effect of Convalescent Plasma therapy on Mortality in Moderate-to-Severely Ill COVID-19 Patients. Transfus Apher Sci 2022; 61:103455. [PMID: 35618641 PMCID: PMC9090870 DOI: 10.1016/j.transci.2022.103455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/24/2022]
Abstract
Introduction The role of plasma therapy in the management of the COVID-19, pandemic has been speculated. However, in view of the varied response regarding its effectiveness from various multicenter studies, there is a need to conduct more single center population-specific studies. We, thus, aimed to assess the role of convalescent plasma therapy in COVID-19 patient management in a single -center. Methods This retrospective study was conducted using records of all COVID-19 patients who received plasma therapy over a period of 6 months in a dedicated COVID-19 hospital in Delhi. Information pertaining to transfusion, disease severity, associated comorbidities, the treatment given and patient outcome were recorded. Data was analyzed using SPSSv23. Results Of the141 patients who received plasma therapy, 62% were discharged after treatment. Mortality was found to be significantly higher in patients > 60 years of age (p < 0.001), those with severe COVID-19 infection (p < 0.05) and pre-existing renal disease (p < 0.05). The admission-transfusion interval was significantly correlated to mortality and was a sensitive parameter for predicting outcome at cut off value of < 5 days (p < 0.001). There was no significant association of mortality with patient blood group, plasma antibody levels or donor hemoglobin levels. Conclusions We report improvement and recovery in a large number of patients who received convalescent plasma within the first 5 days of hospitalization with moderate to severe disease. Further research to compare dosage and administration protocols to delineate role of CCP in survival of COVID-19 patients is needed before it is prematurely shelved.
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Affiliation(s)
- Akanksha Agrawal
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Tanvi Jha
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Priyanka Gogoi
- Department of Pathology, Incharge, Blood Bank and Regional Transfusion Centre, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - Preeti Diwaker
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ashish Goel
- Department of Medicine, Dr BR Ambedkar State Institute of Medical Sciences, Punjab, India
| | - Amir Maroof Khan
- Department of Community Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ashok Kumar Saxena
- Department of Anesthesiology, University College of Medical Sciences and GTB Hospital, Delhi, India
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6
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Lanza F, Agostini V, Monaco F, Passamonti F, Seghatchian J. Therapeutic Use of Convalescent Plasma in COVID-19 Infected Patients with Concomitant Hematological Disorders. Clin Hematol Int 2021; 3:77-82. [PMID: 34820612 PMCID: PMC8486975 DOI: 10.2991/chi.k.210403.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
The use of convalescent plasma (CP) from individuals recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a promising therapeutic modality for the coronavirus disease 2019 (COVID-19). CP has been in use for at least a century to provide passive immunity against a number of diseases, and was recently proposed by the World Health Organization for human Ebola virus infection. Only a few small studies have so far been published on patients with COVID-19 and concomitant hematological malignancies (HM). The Italian Hematology Alliance on HM and COVID-19 has found that HM patients with COVID-19 clinically perform more poorly than those with either HM or COVID-19 alone. A COVID-19 infection in patients with B-cell lymphoma is associated with impaired generation of neutralizing antibody titers and lowered clearance of SARS-CoV-2. Treatment with CP was seen to increase antibody titers in all patients and to improve clinical response in 80% of patients examined. However, a recent study has reported impaired production of SARS-CoV-2-neutralizing antibodies in an immunosuppressed individual treated with CP, possibly supporting the notion of virus escape, particularly in immunocompromised individuals where prolonged viral replication occurs. This may limit the efficacy of CP treatment in at least some HM patients. More recently, it has been shown that CP may provide a neutralising effect against B.1.1.7 and other SARS-CoV-2 variants, thus expanding its application in clinical practice. More extensive studies are needed to further assess the use of CP in COVID-19-infected HM patients.
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Affiliation(s)
- Francesco Lanza
- Hematology Unit & Romagna Transplant Network, Ravenna, Italy
| | - Vanessa Agostini
- Transfusion Medicine Department, IRCCS- Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Monaco
- Hematology Unit & Romagna Transplant Network, Ravenna, Italy
| | | | - Jerard Seghatchian
- International Consultancy in Innovative Manufacturing and Quality/Safety of Blood-Derived Bioproducts, London, England, UK
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7
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Papadopoulou A, Musa H, Sivaganesan M, McCoy D, Deloukas P, Marouli E. COVID-19 susceptibility variants associate with blood clots, thrombophlebitis and circulatory diseases. PLoS One 2021; 16:e0256988. [PMID: 34478452 PMCID: PMC8415605 DOI: 10.1371/journal.pone.0256988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/19/2021] [Indexed: 12/16/2022] Open
Abstract
Epidemiological studies suggest that individuals with comorbid conditions including diabetes, chronic lung, inflammatory and vascular disease, are at higher risk of adverse COVID-19 outcomes. Genome-wide association studies have identified several loci associated with increased susceptibility and severity for COVID-19. However, it is not clear whether these associations are genetically determined or not. We used a Phenome-Wide Association (PheWAS) approach to investigate the role of genetically determined COVID-19 susceptibility on disease related outcomes. PheWAS analyses were performed in order to identify traits and diseases related to COVID-19 susceptibility and severity, evaluated through a predictive COVID-19 risk score. We utilised phenotypic data in up to 400,000 individuals from the UK Biobank, including Hospital Episode Statistics and General Practice data. We identified a spectrum of associations between both genetically determined COVID-19 susceptibility and severity with a number of traits. COVID-19 risk was associated with increased risk for phlebitis and thrombophlebitis (OR = 1.11, p = 5.36e-08). We also identified significant signals between COVID-19 susceptibility with blood clots in the leg (OR = 1.1, p = 1.66e-16) and with increased risk for blood clots in the lung (OR = 1.12, p = 1.45 e-10). Our study identifies significant association of genetically determined COVID-19 with increased blood clot events in leg and lungs. The reported associations between both COVID-19 susceptibility and severity and other diseases adds to the identification and stratification of individuals at increased risk, adverse outcomes and long-term effects.
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Affiliation(s)
- Areti Papadopoulou
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, United Kingdom
| | - Hanan Musa
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mathura Sivaganesan
- Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - David McCoy
- Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, United Kingdom
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Genomic Health, Life Sciences, Queen Mary University of London, London, United Kingdom
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8
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Perenc L, Pęczkowski R. Knowledge and Attitudes of Young Adults Towards Donation of COVID-19 Convalescent Plasma and Its Therapeutic Properties. J Blood Med 2021; 12:709-717. [PMID: 34408520 PMCID: PMC8364396 DOI: 10.2147/jbm.s319652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the level of knowledge of the young adults towards the possible use of the convalescent plasma (CP) in the treatment of COVID-19 infection and their attitudes towards its donation. METHODS Cross-sectional questionnaire was administered online to 1058 university students, representing 4 different colleges. The questionnaire included demographic data and 20 questions related to the knowledge and attitudes of respondents about possible use of the convalescent plasma in the treatment of COVID-19 infection and its donation. Comparative analyses were made using the Mann-Whitney and Kruskal-Wallis tests and the Spearman correlation coefficient. RESULTS Significant relationships were found between dependent variables (level of knowledge and intensity of attitude) and gender, age, and student's college affiliation. There was no statistically significant correlation between dependent variables and respondents' social background and religious commitment. Studied young adults show a satisfactory knowledge relating to the therapeutic and preventive properties of the COVID-19 convalescent plasma. They also express a sufficient intensity of positive attitude towards CP donation. CONCLUSION This study confirms the need for appropriate health promotional campaigns and educational programs aimed at popularization of CP donation in the general public, which would increase the chances of involving more patients recovered from COVID-19 disease.
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Affiliation(s)
- Lidia Perenc
- Institute of Health Sciences, University of Rzeszow, Rzeszow, 35-310, Poland
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9
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Thabrani A, Hadi WS, Thobari JA, Novianti Z, Kurniyanto, Juliana I, Suharto A, Danaswari AN, Septiani I, Rhatomy S. Convalescent plasma as a treatment modality for Coronavirus Disease 2019 in Indonesia: A case reports. Ann Med Surg (Lond) 2021; 66:102444. [PMID: 34094533 PMCID: PMC8165043 DOI: 10.1016/j.amsu.2021.102444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction and importance Coronavirus Disease 2019 (COVID-19) has become a pandemic since the beginning of 2020. COVID-19 is also spreading very rapidly in Indonesia and so far, no definitive therapy has been found. Case presentation We report two cases of confirmed COVID-19 with moderate pneumonia, who received 400 ml of convalescent plasma and showed improvements in clinical, laboratory and radiological examinations. Clinical discussion Passive immunotherapy is generally more effective when given early. Plasma transfusion is more beneficial when given before clinical conditions become severe. Some studies have shown that therapy with convalescent plasma can contribute to a longer survival and a lower length of stay. Conclusion Convalescent plasma can be used as an adjunctive therapy option for patients with moderate COVID-19.
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Affiliation(s)
- Achmad Thabrani
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wahid Syamsul Hadi
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jarir At Thobari
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Zakiah Novianti
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kurniyanto
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Indah Juliana
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Agus Suharto
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Atik Nuriyah Danaswari
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ika Septiani
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sholahuddin Rhatomy
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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10
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Furlan A, Forner G, Cipriani L, Vian E, Rigoli R, Gherlinzoni F, Scotton P. Dramatic Response to Convalescent Hyperimmune Plasma in Association With an Extended Course of Remdesivir in 4 B Cell-Depleted Non-Hodgkin Lymphoma Patients With SARS-Cov-2 Pneumonia After Rituximab Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e731-e735. [PMID: 34217677 PMCID: PMC8139434 DOI: 10.1016/j.clml.2021.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/08/2023]
Abstract
Four B cell–depleted non-Hodgkin lymphoma (NHL) patients with SARS-CoV-2 pneumonia after rituximab therapy were initially treated with a 5-day remdesivir course and steroids. After transient virologic and clinical response, they all experienced early relapse and subsequent prolonged disease course, with rapid and significant response to convalescent hyperimmune plasma in association with an extended course of remdesivir. The clinical observations here reported suggest that the immunological effects of Rituximab treatment in NHL patients should be taken into account for the proper choice and interpretation of SARS-CoV-2 laboratory tests and to guide the appropriate therapeutical approach.
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Affiliation(s)
- Anna Furlan
- Hematology Unit, Azienda ULSS2 Marca Trevigiana, Italy.
| | | | | | - Elisa Vian
- Microbiology Unit, Azienda ULSS2 Marca Trevigiana, Italy
| | - Roberto Rigoli
- Microbiology Unit, Azienda ULSS2 Marca Trevigiana, Italy
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11
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Fatima N, Kaushik V, Ayoub A. A Narrative Review of a Pulmonary Aerosolized Formulation or a Nasal Drop Using Sera Containing Neutralizing Antibodies Collected from COVID-19-Recovered Patients as a Probable Therapy for COVID-19. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:151-168. [PMID: 34083848 PMCID: PMC8163704 DOI: 10.30476/ijms.2020.86417.1624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) emerged as a new contagion during December 2019, since which time it has triggered a rampant spike in fatality rates worldwide due to insufficient medical treatments and a lack of counteragents and prompted the World Health Organization to declare COVID-19 a public health emergency. It is, therefore, vital to accelerate the screening of new molecules or vaccines to win the battle against this pandemic. Experiences from previous epidemiological data on coronaviruses guide investigators in designing and exploring new compounds for a safe and cost-effective treatment. Several reports on the severe acute respiratory syndrome (SARS) epidemic indicate that severe acute respiratory syndrome coronavirus (SARS-CoV) and the novel COVID-19 use angiotensin-converting enzyme 2 (ACE2) as a receptor for binding to the host cell in the lung epithelia through the spike protein on their virion surface. ACE2 is a mono-carboxypeptidase best known for cleaving major peptides and substrates. Its degree in human airway epithelia positively correlates with coronavirus infection. The treatment approach can be the neutralization of the virus entering lung epithelial cells by using sera containing antibodies collected from COVID-19-recovered patients. Hence, we herein propose a pulmonary aerosolized formulation or a nasal drop using sera, which contain antibodies to prevent, treat, or immunize against COVID-19 infection.
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Affiliation(s)
- Nishat Fatima
- School of Pharmacy, Al-Hawash Private University, Homs, Syria
| | | | - Amjad Ayoub
- School of Pharmacy, Al-Hawash Private University, Homs, Syria
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12
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Peng HT, Rhind SG, Beckett A. Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis. JMIR Public Health Surveill 2021; 7:e25500. [PMID: 33825689 PMCID: PMC8245055 DOI: 10.2196/25500] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic, caused by a novel coronavirus termed SARS-CoV-2, has spread quickly worldwide. Convalescent plasma (CP) obtained from patients following recovery from COVID-19 infection and development of antibodies against the virus is an attractive option for either prophylactic or therapeutic treatment, since antibodies may have direct or indirect antiviral activities and immunotherapy has proven effective in principle and in many clinical reports. OBJECTIVE We seek to characterize the latest advances and evidence in the use of CP for COVID-19 through a systematic review and quantitative analysis, identify knowledge gaps in this setting, and offer recommendations and directives for future research. METHODS PubMed, Web of Science, and Embase were continuously searched for studies assessing the use of CP for COVID-19, including clinical studies, commentaries, reviews, guidelines or protocols, and in vitro testing of CP antibodies. The screening process and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal of all clinical studies was conducted using a universal tool independent of study designs. A meta-analysis of case-control and randomized controlled trials (RCTs) was conducted using a random-effects model. RESULTS Substantial literature has been published covering various aspects of CP therapy for COVID-19. Of the references included in this review, a total of 243 eligible studies including 64 clinical studies, 79 commentary articles, 46 reviews, 19 guidance and protocols, and 35 in vitro testing of CP antibodies matched the criteria. Positive results have been mostly observed so far when using CP for the treatment of COVID-19. There were remarkable heterogeneities in the CP therapy with respect to patient demographics, donor antibody titers, and time and dose of CP administration. The studies assessing the safety of CP treatment reported low incidence of adverse events. Most clinical studies, in particular case reports and case series, had poor quality. Only 1 RCT was of high quality. Randomized and nonrandomized data were found in 2 and 11 studies, respectively, and were included for meta-analysis, suggesting that CP could reduce mortality and increase viral clearance. Despite promising pilot studies, the benefits of CP treatment can only be clearly established through carefully designed RCTs. CONCLUSIONS There is developing support for CP therapy, particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. These studies provide important lessons that should inform the planning of well-designed RCTs to generate more robust knowledge for the efficacy of CP in patients with COVID-19. Future research is necessary to fill the knowledge gap regarding prevention and treatment for patients with COVID-19 with CP while other therapeutics are being developed.
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Affiliation(s)
- Henry T Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Andrew Beckett
- St. Michael's Hospital, Toronto, ON, Canada
- Royal Canadian Medical Services, Ottawa, ON, Canada
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13
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Gontu A, Srinivasan S, Salazar E, Nair MS, Nissly RH, Greenawalt D, Bird IM, Herzog CM, Ferrari MJ, Poojary I, Katani R, Lindner SE, Minns AM, Rossi R, Christensen PA, Castillo B, Chen J, Eagar TN, Yi X, Zhao P, Leveque C, Olsen RJ, Bernard DW, Gollihar J, Kuchipudi SV, Musser JM, Kapur V. Limited window for donation of convalescent plasma with high live-virus neutralizing antibody titers for COVID-19 immunotherapy. Commun Biol 2021; 4:267. [PMID: 33627795 PMCID: PMC7904946 DOI: 10.1038/s42003-021-01813-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
Millions of individuals who have recovered from SARS-CoV-2 infection may be eligible to participate in convalescent plasma donor programs, yet the optimal window for donating high neutralizing titer convalescent plasma for COVID-19 immunotherapy remains unknown. Here we studied the response trajectories of antibodies directed to the SARS-CoV-2 surface spike glycoprotein and in vitro SARS-CoV-2 live virus neutralizing titers (VN) in 175 convalescent donors longitudinally sampled for up to 142 days post onset of symptoms (DPO). We observed robust IgM, IgG, and viral neutralization responses to SARS-CoV-2 that persist, in the aggregate, for at least 100 DPO. However, there is a notable decline in VN titers ≥160 for convalescent plasma therapy, starting 60 DPO. The results also show that individuals 30 years of age or younger have significantly lower VN, IgG and IgM antibody titers than those in the older age groups; and individuals with greater disease severity also have significantly higher IgM and IgG antibody titers. Taken together, these findings define the optimal window for donating convalescent plasma useful for immunotherapy of COVID-19 patients and reveal important predictors of an ideal plasma donor.
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Affiliation(s)
- Abhinay Gontu
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA
| | - Sreenidhi Srinivasan
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Eric Salazar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Meera Surendran Nair
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA
| | - Ruth H Nissly
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA
| | - Denver Greenawalt
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA
| | - Ian M Bird
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA
| | - Catherine M Herzog
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Matthew J Ferrari
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
- Department of Biology, Pennsylvania State University, University Park, PA, USA
| | - Indira Poojary
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Robab Katani
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Scott E Lindner
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
- Department of Biochemistry, Microbiology, and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Allen M Minns
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
- Department of Biochemistry, Microbiology, and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Randall Rossi
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Paul A Christensen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Brian Castillo
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jian Chen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Todd N Eagar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Xin Yi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Picheng Zhao
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Christopher Leveque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
- Center for Molecular and Translational Human Infectious Diseases, Houston Methodist Research Institute, Houston, TX, USA
| | - David W Bernard
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Center for Molecular and Translational Human Infectious Diseases, Houston Methodist Research Institute, Houston, TX, USA
| | - Jimmy Gollihar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- CCDC Army Research Laboratory-South, Austin, TX, USA
| | - Suresh V Kuchipudi
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA.
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA.
| | - James M Musser
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.
- Department of Biochemistry, Microbiology, and Molecular Biology, Pennsylvania State University, University Park, PA, USA.
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Vivek Kapur
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA.
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA.
- Department of Animal Science, Pennsylvania State University, University Park, PA, USA.
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14
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Aydemir D, Ulusu NN. People with blood disorders can be more vulnerable during COVID-19 pandemic: A hypothesis paper. Transfus Apher Sci 2021; 60:103080. [PMID: 33608217 PMCID: PMC7874911 DOI: 10.1016/j.transci.2021.103080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/12/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
The world has been encountered with COVID-19 pandemic since at the beginning of 2020 and the number of infected people by COVID-19 is increasing every day. Despite various studies conducted by researchers and doctors, no treatment has been developed until now, therefore self-protection and isolation are strongly recommended to stop the spread of the virus. The elderly population and people with chronic diseases such as hypertension, cardiovascular diseases, diabetes, and cancer are categorized as risk groups, however, we suggest that people with hemoglobinopathies or porphyria can be described as risk groups as well. Current in silico studies have revealed that the COVID-19 virus can attack heme and hemoglobin metabolisms which are responsible for the oxygen transport to the tissues, iron metabolism, elevated levels of oxidative stress, and tissue damage. Data of the in silico study have been supported with the biochemistry and hemogram results of the COVID-19 patients, for instance hemoglobin levels decreased and serum ferritin and C-reactive protein levels increased. Indicated biochemistry biomarkers are tightly associated with inflammation, iron overload, and oxidative stress. In conclusion, since people with hemoglobinopathies or porphyria have already impaired heme and hemoglobin metabolism, COVID-19 infection can enhance the adverse effects of impaired hemoglobin metabolism and accelerate the progression of severe symptoms in patients with hemoglobinopathies or porphyria compared to the normal individuals. Thus those people can be considered as a risk group and extra precautions should be applied for them to protect them.
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Affiliation(s)
- Duygu Aydemir
- Koc University, School of Medicine, Rumelifeneri Yolu, Sariyer, 34450, Istanbul, Turkey; Koc University Research Center for Translational Medicine (KUTTAM), Sariyer, 34450, Istanbul, Turkey
| | - Nuriye Nuray Ulusu
- Koc University, School of Medicine, Rumelifeneri Yolu, Sariyer, 34450, Istanbul, Turkey; Koc University Research Center for Translational Medicine (KUTTAM), Sariyer, 34450, Istanbul, Turkey.
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15
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Hassan MO, Osman AA, Elbasit HEA, Hassan HE, Rufai H, Satti MMM, Elnegoumi M, Idris R, Musa A, Ali AH, Zroog SA, Altayb ADA, Khairy A, Allam M, Abdelhalim ATI. Convalescent plasma as a treatment modality for coronavirus disease 2019 in Sudan. Transfus Apher Sci 2020; 59:102918. [PMID: 32900597 PMCID: PMC7450236 DOI: 10.1016/j.transci.2020.102918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a disease spreading rapidly in Sudan, the rest of the African continent and the world with no known definitive treatment or vaccines. However, among many treatment interventions being tested globally, beneficial effects and clinical improvements have been reported when convalescent plasma is used for treating COVID-19 patients. We prepared a guiding protocol for treating early to moderate COVID-19 patients with plasma transfusion from convalescent COVID-19 patients. This protocol was deduced based on previously published reports and studies that evaluated and tested convalescent plasma as a prospective therapy for COVID-19 patients. The protocol covers instructions on patient and donor selection criteria, plasma harvesting, plasma product specifications, dosage and precautions for convalescent plasma collection and transfusion process. Altogether, we prepared a treatment protocol that is tailored to the context of Sudan to be adopted by Sudan's health authority. Moreover, it will also provide reference for researchers to design open label clinical trials for convalescent plasma transfusion.
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Affiliation(s)
- Mozan Osman Hassan
- Faculty of Medical Laboratory Science, Omdurman Ahlia University, Sudan.
| | - Asma Ahmed Osman
- Faculty of Medicine and Health Science, Omdurman Islamic University, Sudan
| | | | | | - Hala Rufai
- National Blood Transfusion Services, Federal Ministry of Health, Sudan
| | - Maria M M Satti
- National Blood Transfusion Services, Federal Ministry of Health, Sudan
| | - Musab Elnegoumi
- Diseases Control Directorate, Federal Ministry of Health, Sudan
| | - Roaa Idris
- University of Wolverhampton, United Kingdom
| | | | - Abdelhakam H Ali
- Faculty of Medical Laboratory Science, University of Al Butana, Sudan
| | - Susan Ali Zroog
- Faculty of Applied Medical Science, University of Al Butana, Sudan
| | | | - Amna Khairy
- Diseases Control Directorate, Federal Ministry of Health, Sudan
| | - Mushal Allam
- National Institute for Communicable Diseases, National Health Laboratory Service, South Africa
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16
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Clinical trial protocols of repurposed prophylaxis for COVID-19: A review. Infect Dis Now 2020; 51:7-13. [PMID: 33022293 PMCID: PMC7532748 DOI: 10.1016/j.medmal.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Abstract
Efficient therapeutic strategies are needed to counter the COVID-19 pandemic, caused by the SARS-CoV-2 virus. In a context where specific vaccines are not yet available, the containment of the pandemic would be facilitated with efficient prophylaxis. We screened several clinical trials repositories and platforms in search of the prophylactic strategies being investigated against COVID-19 in July 2020. Up to July 5, 2020, only one clinical trial result was published, although we found 112 clinical trial protocols targeting medical workers (n = 70, 63%), patients relatives (n = 20, 18%) or individuals at risk of severe COVID-19 (n = 14, 13%). (Hydroxy)chloroquine was the most frequently evaluated treatment (n = 69, 62%), before BCG vaccine (n = 12, 11%), this followed by numerous antivirals and immune enhancers. Ninety-eight (88%) clinical trials were randomized with a median of planned inclusions of 530 (IQR 258–1299). Both pre- and post-exposure prophylaxes are investigated.
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17
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Duyu M, Turkozkan C. Therapeutic plasma exchange in the pediatric intensive care unit: A single-center 5-Year experience. Transfus Apher Sci 2020; 59:102959. [PMID: 33011077 DOI: 10.1016/j.transci.2020.102959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/24/2023]
Abstract
The objective of this study is to characterize clinical indications, safety and outcome with the use of TPE in critically ill children. All TPE procedures performed in a tertiary pediatric intensive care unit (PICU) during a 5-year period were retrospectively evaluated. A total of 75 patients underwent 249 sessions of TPE. Sepsis-induced multiple organ dysfunction syndrome (MODS) was the most common indication with 29.3 %. American Society for Apheresis classifications were as follows: Category I: 24 %, Category II: 16 %, Category III: 45.3 % and Category IV: 4%, while 10.7 % of the patients could not be classified. TPE was performed without any adjunct procedures in 188 sessions (75.5 %), while it was combined with continuous renal replacement therapy (CRRT) in 49 sessions (19.7 %) and with CRRT and extracorporeal membrane oxygenation (ECMO) in 12 (4.8 %) sessions. Overall survival rate was 73.3 %. The survival rate in patients requiring only TPE was 86.5 %, while the survival rates of patients who had CRRT and ECMO were 45 % and 33.3 %, respectively. Complications associated with the procedure occurred in 48 (19.2 %) TPE sessions. The lowest survival rate (31.9 %) was in patients with sepsis-induced MODS. Finally, we also found significantly higher organ failure rate, mechanical ventilation requirement, and PRISM III score at PICU admission in non-survivors. Our experience indicates that TPE can be performed relatively safely in critically ill children with appropriate treatment indications. Survival rate may vary depending on the underlying disease; however, it must be noted that survival rate is very high in children requiring TPE only.
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Affiliation(s)
- Muhterem Duyu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
| | - Ceren Turkozkan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey.
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18
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Seghatchian J, Acker JP, Putter JS. Update on newer approaches to prevent or treat COVID-19 infection: What we all need the most right now!! Transfus Apher Sci 2020; 59:102933. [PMID: 32919879 PMCID: PMC7470817 DOI: 10.1016/j.transci.2020.102933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
COVID-19 convalescent plasma (CCP) therapy involves the use of circulating antibodies administration from recovered COVID 19 patients as a practical strategy to provide immediate passive immunity in susceptible recipients in need. Global concern over the potential for “second” or “third” waves of infection to occur before effective vaccines or drug therapies are available has many looking at other biological sources for large-scale production of neutralizing SARS-CoV-2 antibodies. This report summarizes some of the novel strategies for developing alternative safe sources of therapeutic autologous antibodies from COVID ‐19 infected patients, and provides some original thoughts on how to rapidly implement a safe passive immunity in those COVID-19 patients who are most in need of intervention. COVID-19 antibodies can be isolated or delivered using a number of other techniques including: plasmapheresis, plasma cryoprecipitate reduced (cryosupernatant), antibody hyperconcentrates and advanced cell-based delivery systems. While these proposed technological options may, in some cases, be theoretical, the growing concern over the rapid spread of the SARS-CoV-2 virus has prompted many to pursue innovative and creative solutions to reduce the mortality and morbidity resulting from the current global pandemic. A comparative analysis of various strategies currently in use deserved exploring and this highlighted separately as the essential part of this concise theme.
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Affiliation(s)
- Jerard Seghatchian
- International Consultancy in Strategic Safety/ Quality Innovations of Blood- Derived Bioproducts and Quality Audit / Inspection, London, England, UK
| | - Jason P Acker
- Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
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19
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Akkoyunlu Y, Cetin G, Bolukcu S, Okay G, Ogun H, Durdu B, Okyaltirik F, Karaaslan K. The successful management of an elderly Covid-19 infected patient by plasmapheresis. Transfus Apher Sci 2020; 59:102924. [PMID: 32883594 PMCID: PMC7446620 DOI: 10.1016/j.transci.2020.102924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Yasemin Akkoyunlu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey.
| | - Guven Cetin
- Department of Hematology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Gulay Okay
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Hamza Ogun
- Department of Chest Diseases, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatmanur Okyaltirik
- Department of Chest Diseases, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
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Piechotta V, Chai KL, Valk SJ, Doree C, Monsef I, Wood EM, Lamikanra A, Kimber C, McQuilten Z, So-Osman C, Estcourt LJ, Skoetz N. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2020; 7:CD013600. [PMID: 32648959 PMCID: PMC7389743 DOI: 10.1002/14651858.cd013600.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required. OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS We searched the World Health Organization (WHO) COVID-19 Global Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, Centers for Disease Control and Prevention COVID-19 Research Article Database and trial registries to identify completed and ongoing studies on 4 June 2020. SELECTION CRITERIA We followed standard Cochrane methodology. We included studies evaluating convalescent plasma or hyperimmune immunoglobulin for people with COVID-19, irrespective of study design, disease severity, age, gender or ethnicity. We excluded studies including populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)) and studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane 'Risk of bias' tool for randomised controlled trials (RCTs), the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool for controlled non-randomised studies of interventions (NRSIs), and the assessment criteria for observational studies, provided by Cochrane Childhood Cancer for non-controlled NRSIs. MAIN RESULTS: This is the first living update of our review. We included 20 studies (1 RCT, 3 controlled NRSIs, 16 non-controlled NRSIs) with 5443 participants, of whom 5211 received convalescent plasma, and identified a further 98 ongoing studies evaluating convalescent plasma or hyperimmune immunoglobulin, of which 50 are randomised. We did not identify any completed studies evaluating hyperimmune immunoglobulin. Overall risk of bias of included studies was high, due to study design, type of participants, and other previous or concurrent treatments. Effectiveness of convalescent plasma for people with COVID-19 We included results from four controlled studies (1 RCT (stopped early) with 103 participants, of whom 52 received convalescent plasma; and 3 controlled NRSIs with 236 participants, of whom 55 received convalescent plasma) to assess effectiveness of convalescent plasma. Control groups received standard care at time of treatment without convalescent plasma. All-cause mortality at hospital discharge (1 controlled NRSI, 21 participants) We are very uncertain whether convalescent plasma has any effect on all-cause mortality at hospital discharge (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61 to 1.31; very low-certainty evidence). Time to death (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma prolongs time to death (RCT: hazard ratio (HR) 0.74, 95% CI 0.30 to 1.82; controlled NRSI: HR 0.46, 95% CI 0.22 to 0.96; very low-certainty evidence). Improvement of clinical symptoms, assessed by need for respiratory support (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma has any effect on improvement of clinical symptoms at seven days (RCT: RR 0.98, 95% CI 0.30 to 3.19), 14 days (RCT: RR 1.85, 95% CI 0.91 to 3.77; controlled NRSI: RR 1.08, 95% CI 0.91 to 1.29), and 28 days (RCT: RR 1.20, 95% CI 0.80 to 1.81; very low-certainty evidence). Quality of life No studies reported this outcome. Safety of convalescent plasma for people with COVID-19 We included results from 1 RCT, 3 controlled NRSIs and 10 non-controlled NRSIs assessing safety of convalescent plasma. Reporting of adverse events and serious adverse events was variable. The controlled studies reported on adverse events and serious adverse events only in participants receiving convalescent plasma. The duration of follow-up varied. Some, but not all, studies included death as a serious adverse event. Grade 3 or 4 adverse events (13 studies, 201 participants) The studies did not report the grade of adverse events. Thirteen studies (201 participants) reported on adverse events of possible grade 3 or 4 severity. The majority of these adverse events were allergic or respiratory events. We are very uncertain whether or not convalescent plasma therapy affects the risk of moderate to severe adverse events (very low-certainty evidence). Serious adverse events (14 studies, 5201 participants) Fourteen studies (5201 participants) reported on serious adverse events. The majority of participants were from one non-controlled NRSI (5000 participants), which reported only on serious adverse events limited to the first four hours after convalescent plasma transfusion. This study included death as a serious adverse event; they reported 15 deaths, four of which they classified as potentially, probably or definitely related to transfusion. Other serious adverse events reported in all studies were predominantly allergic or respiratory in nature, including anaphylaxis, transfusion-associated dyspnoea, and transfusion-related acute lung injury (TRALI). We are very uncertain whether or not convalescent plasma affects the number of serious adverse events. AUTHORS' CONCLUSIONS We are very uncertain whether convalescent plasma is beneficial for people admitted to hospital with COVID-19. For safety outcomes we also included non-controlled NRSIs. There was limited information regarding adverse events. Of the controlled studies, none reported on this outcome in the control group. There is only very low-certainty evidence for safety of convalescent plasma for COVID-19. While major efforts to conduct research on COVID-19 are being made, problems with recruiting the anticipated number of participants into these studies are conceivable. The early termination of the first RCT investigating convalescent plasma, and the multitude of studies registered in the past months illustrate this. It is therefore necessary to critically assess the design of these registered studies, and well-designed studies should be prioritised. Other considerations for these studies are the need to report outcomes for all study arms in the same way, and the importance of maintaining comparability in terms of co-interventions administered in all study arms. There are 98 ongoing studies evaluating convalescent plasma and hyperimmune immunoglobulin, of which 50 are RCTs. This is the first living update of the review, and we will continue to update this review periodically. These updates may show different results to those reported here.
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Affiliation(s)
- Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Abigail Lamikanra
- Clinical, Research and Development, NHS Blood and Transplant, Oxford, UK
| | - Catherine Kimber
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cynthia So-Osman
- Sanquin Blood Bank, Amsterdam, Netherlands
- Erasmus Medical Centre, Rotterdam, Netherlands
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Cantore I, Valente P. Convalescent plasma from COVID 19 patients enhances intensive care unit survival rate. A preliminary report. Transfus Apher Sci 2020; 59:102848. [PMID: 32888822 PMCID: PMC7283069 DOI: 10.1016/j.transci.2020.102848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Italo Cantore
- San Carlo Regional Hospital, Via Potito Petrone, 85100, Potenza, Italy.
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Seghatchian J, Lanza F. Convalescent plasma, an apheresis research project targeting and motivating the fully recovered COVID 19 patients: A rousing message of clinical benefit to both donors and recipients alike. Transfus Apher Sci 2020; 59:102794. [PMID: 32448638 PMCID: PMC7177094 DOI: 10.1016/j.transci.2020.102794] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Seghatchian
- International Consultancy in Strategic Advice on Safety Improvements of Blood-Derived Bioproducts and Suppliers Quality Audit / Inspection, London, UK.
| | - F Lanza
- Romagna Transplant Network, Hematology Unit, Ravenna-I, Italy
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