1
|
Senefeld JW, Franchini M, Mengoli C, Cruciani M, Zani M, Gorman EK, Focosi D, Casadevall A, Joyner MJ. COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2250647. [PMID: 36633846 PMCID: PMC9857047 DOI: 10.1001/jamanetworkopen.2022.50647] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023] Open
Abstract
Importance Patients who are immunocompromised have increased risk for morbidity and mortality associated with coronavirus disease 2019 (COVID-19) because they less frequently mount antibody responses to vaccines. Although neutralizing anti-spike monoclonal-antibody treatment has been widely used to treat COVID-19, evolutions of SARS-CoV-2 have been associated with monoclonal antibody-resistant SARS-CoV-2 variants and greater virulence and transmissibility of SARS-CoV-2. Thus, the therapeutic use of COVID-19 convalescent plasma has increased on the presumption that such plasma contains potentially therapeutic antibodies to SARS-CoV-2 that can be passively transferred to the plasma recipient. Objective To assess the growing number of reports of clinical experiences of patients with COVID-19 who are immunocompromised and treated with specific neutralizing antibodies via COVID-19 convalescent plasma transfusion. Data Sources On August 12, 2022, a systematic search was performed for clinical studies of COVID-19 convalescent plasma use in patients who are immunocompromised. Study Selection Randomized clinical trials, matched cohort studies, and case report or series on COVID-19 convalescent plasma use in patients who are immunocompromised were included. The electronic search yielded 462 unique records, of which 199 were considered for full-text screening. Data Extraction and Synthesis The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 3 independent reviewers in duplicate and pooled. Main Outcomes and Meaures The prespecified end point was all-cause mortality after COVID-19 convalescent plasma transfusion; exploratory subgroup analyses were performed based on putative factors associated with the potential mortality benefit of convalescent plasma. Results This systematic review and meta-analysis included 3 randomized clinical trials enrolling 1487 participants and 5 controlled studies. Additionally, 125 case series or reports enrolling 265 participants and 13 uncontrolled large case series enrolling 358 participants were included. Separate meta-analyses, using models both stratified and pooled by study type (ie, randomized clinical trials and matched cohort studies), demonstrated that transfusion of COVID-19 convalescent plasma was associated with a decrease in mortality compared with the control cohort for the amalgam of both randomized clinical trials and matched cohort studies (risk ratio [RR], 0.63 [95% CI, 0.50-0.79]). Conclusions and Relevance These findings suggest that transfusion of COVID-19 convalescent plasma is associated with mortality benefit for patients who are immunocompromised and have COVID-19.
Collapse
Affiliation(s)
- Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Massimo Franchini
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Carlo Mengoli
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Mario Cruciani
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Matteo Zani
- Division of Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Tomita N, Saito S, Terada-Hirashima J, Mikami A, Uemura Y, Kutsuna S, Nomoto H, Fujisawa K, Nagashima M, Terada M, Ashida S, Morioka S, Satake M, Hangaishi A, Togano T, Shiratori K, Takamatsu Y, Maeda K, Ohmagari N, Sugiura W, Mitsuya H. A Multi-Center, Open-Label, Randomized Controlled Trial to Evaluate the Efficacy of Convalescent Plasma Therapy for Coronavirus Disease 2019: A Trial Protocol (COVIPLA-RCT). LIFE (BASEL, SWITZERLAND) 2022; 12:life12060856. [PMID: 35743887 PMCID: PMC9225318 DOI: 10.3390/life12060856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
Background: Coronavirus disease 2019 is a global public health concern. As of December 2020, the therapeutic agents approved for coronavirus disease 2019 in Japan were limited to two drugs: remdesivir, an antiviral drug, granted a Special Approval for Emergency on 7 May 2020, and dexamethasone, which has an anti-inflammatory effect. The aim of this study is to evaluate the efficacy of convalescent plasma collected from donors who recovered from coronavirus disease 2019. Methods: This is an open-label, randomized controlled trial comprising two groups: a convalescent plasma and a standard-of-care group. Plasma administered to patients with coronavirus disease 2019 randomized in the convalescent plasma group of this trial will be plasma that has been collected and stored in an associated study. Patients with a diagnosis of mild coronavirus disease 2019 will be included in this trial. The efficacy of convalescent plasma transfusion will be evaluated by comparing the convalescent plasma group to the standard-of-care group (without convalescent plasma transfusion) with respect to changes in the viral load and other measures. The primary endpoint will be time-weighted average changes in the SARS-CoV-2 virus load in nasopharyngeal swabs from day 0 to days 3 and 5. It is hypothesized that the intervention should result in a decrease in the viral load in the convalescent plasma group until day 5. This endpoint has been used as a change in viral load has and been used as an index of therapeutic effect in several previous studies. Discussion: The proposed trial has the potential to prevent patients with mild COVID-19 from developing a more severe illness. Several RCTs of convalescent plasma therapy have already been conducted in countries outside of Japan, but no conclusion has been reached with respect to the efficacy of convalescent plasma therapy, which is likely in part because of the heterogeneity of the types of target patients, interventions, and endpoints among trials. Actually, previous clinical trials on plasma therapy have shown inconsistent efficacy and are sometimes ineffective in COVID-19 patients with severe disease, which is due to unmeasured neutralizing antibody titer in the COVID-19 convalescent plasma. To improve this issue, in this study, we measure neutralizing activity of convalescent plasma before administration and provide the plasma with high neutralizing activity to the subjects. It is hoped that this study will further evidence to support the role of convalescent plasma therapy in COVID-19.
Collapse
Affiliation(s)
- Noriko Tomita
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
| | - Sho Saito
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Junko Terada-Hirashima
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
- Correspondence: ; Tel.: +81-3-3202-7181; Fax: +81-3-5273-6941
| | - Ayako Mikami
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
| | - Yukari Uemura
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
- Department of Infection Control and Prevention, Osaka University Hospital, Osaka 565-0871, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Kyoko Fujisawa
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Maki Nagashima
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Mari Terada
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Shinobu Ashida
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Shinichiro Morioka
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross Society, Tokyo 135-8521, Japan;
| | - Akira Hangaishi
- Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (A.H.); (T.T.)
| | - Tomiteru Togano
- Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (A.H.); (T.T.)
| | - Katsuyuki Shiratori
- Labotatory Testing Department, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
| | - Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (Y.T.); (K.M.); (H.M.)
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (Y.T.); (K.M.); (H.M.)
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (S.S.); (S.K.); (H.N.); (K.F.); (M.N.); (S.A.); (S.M.); (N.O.)
| | - Wataru Sugiura
- Center for Clinical Sciences, Center Hospital of the National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (N.T.); (A.M.); (Y.U.); (M.T.); (W.S.)
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (Y.T.); (K.M.); (H.M.)
| |
Collapse
|