Convalescent Plasma in the Treatment of Severe COVID-19: A Systematic Review and Meta-Analysis

Analysis on the Selection of Herbs in TCM COVID-19 Treatment Protocols Between Malaysia and China

Objective

Both Malaysian and Chinese populations have benefited from the utilization of Traditional Chinese Medicine (TCM) in the treatment of COVID-19. This study aims to analyze the herb selection in TCM COVID-19 treatment protocols employed by Malaysia and China.

Methods

Based on TCM theories, a comparative analysis was conducted on the treatment protocols of the two countries. This analysis encompassed syndrome differentiation and classification, therapeutic principles and formulas, as well as herb characteristics. The herbs within the protocols were subjected to frequency statistics and cluster analysis using SPSS 25, and network analysis was performed using SPSS Modeler 18.0 software.

Results

The properties (cold, warm, ping and bitter, pungent, sweet) and meridian (lung, stomach, spleen) associated with the herbs in both protocols exhibit fundamental similarities. Furthermore, the propensity for selecting pairs of herbs is also consistent. The herb pairs selected also have the same propensity. The clustering results reveal six categories, of which in the two protocols are good. The top three herb-pairs in Malaysian Protocols are Gan Cao - Yi Yi Ren, Ban Xia - Gan Cao, Chen Pi - Gan Cao, while the top three in Chinese Protocol are Huo Xiang - Ma Huang, Shi Gao - Gan Cao, Cang Zhu - Gan Cao.

Conclusion

Characteristics of herbs in Both Malaysian and Chinese Protocols herb reflect the advantages and regional adaptation of TCM principles. These findings offer valuable guidance in the application of herbs or herb pairs for the treatment of COVID-19.

Blood plasma supply chain planning to respond COVID-19 pandemic: a case study

The COVID-19 pandemic causes a severe threat to human lives worldwide. Convalescent plasma as supportive care for COVID-19 is critical in reducing the death rate and staying in hospitals. Designing an efficient supply chain network capable of managing convalescent plasma in this situation seems necessary. Although many researchers investigated supply chains of blood products, no research was conducted on the planning of convalescent plasma in the supply chain framework with specific features of COVID-19. This gap is covered in the current work by simultaneous regular and convalescent plasma flow in a supply chain network. Besides, due to the growing importance of environmental problems, the resulting carbon emission from transportation activities is viewed to provide a green network. In other words, this study aims to plan the integrated green supply chain network of regular and convalescent plasma in the pandemic outbreak of COVID-19 for the first time. The presented mixed-integer multi-objective optimization model determines optimal network decisions while minimizing the total cost and total carbon emission. The Epsilon constraint method is used to handle the considered objectives. The model is applied to a real case study from the capital of Iran. Sensitivity analyses are carried out, and managerial insights are drawn. Based on the obtained results, product demand impacts the objective functions significantly. Moreover, the systems' total carbon emission is highly dependent on the flow of regular plasma. The results also reveal that changing transportation emission unit causes significant variation in the total emission while the total cost remains fixed.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials

BACKGROUND

Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ).

METHODS

In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence.

RESULTS

A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis.

CONCLUSIONS

Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Safety and Efficacy of Convalescent Plasma in COVID-19: An Overview of Systematic Reviews

Convalescent plasma (CP) from patients recovered from COVID-19 is one of the most studied anti-viral therapies against SARS-COV-2 infection. The aim of this study is to summarize the evidence from the available systematic reviews on the efficacy and safety of CP in COVID-19 through an overview of the published systematic reviews (SRs). A systematic literature search was conducted up to August 2021 in Embase, PubMed, Web of Science, Cochrane and Medrxiv databases to identify systematic reviews focusing on CP use in COVID-19. Two review authors independently evaluated reviews for inclusion, extracted data and assessed quality of evidence using AMSTAR (A Measurement Tool to Assess Reviews) and GRADE tools. The following outcomes were analyzed: mortality, viral clearance, clinical improvement, length of hospital stay, adverse reactions. In addition, where possible, subgroup analyses were performed according to study design (e.g., RCTs vs. non-RCTs), CP neutralizing antibody titer and timing of administration, and disease severity. The methodological quality of included studies was assessed using the checklist for systematic reviews AMSTAR-2 and the GRADE assessment. Overall, 29 SRs met the inclusion criteria based on 53 unique primary studies (17 RCT and 36 non-RCT). Limitations to the methodological quality of reviews most commonly related to absence of a protocol (11/29) and funding sources of primary studies (27/29). Of the 89 analyses on which GRADE judgements were made, effect estimates were judged to be of high/moderate certainty in four analyses, moderate in 38, low in 38, very low in nine. Despite the variability in the certainty of the evidence, mostly related to the risk of bias and inconsistency, the results of this umbrella review highlight a mortality reduction in CP over standard therapy when administered early and at high titer, without increased adverse reactions.