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Terada M, Saito S, Kutsuna S, Kinoshita-Iwamoto N, Togano T, Hangaishi A, Shiratori K, Takamatsu Y, Maeda K, Ishizaka Y, Ohtsu H, Satake M, Mitsuya H, Ohmagari N. Efficacy and Safety of Treatment with Plasma from COVID-19-Recovered Individuals. Life (Basel) 2023; 13:2184. [PMID: 38004324 PMCID: PMC10671928 DOI: 10.3390/life13112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Convalescent plasma therapy, which involves administering plasma from recovered coronavirus disease 2019 (COVID-19) patients to infected individuals, is being explored as a potential treatment for severe cases of COVID-19. This study aims to evaluate the efficacy and safety of convalescent plasma therapy in COVID-19 patients with moderate to severe illness. An open-label, single-arm intervention study was conducted without a control group. Plasma collected from recovered COVID-19 patients was administered to eligible participants. The primary endpoint was the proportion of patients who were placed on artificial ventilation or died within 14 days of transfusion. Secondary endpoints included clinical improvement, viral load measurements, and adverse event monitoring. A total of 59 cases were included in the study. The primary endpoint was evaluated by comparing the rate obtained in the study to an existing rate of 25%. The study also assessed clinical improvement, viral load changes, and safety endpoints through adverse event monitoring. Convalescent plasma therapy shows potential as a treatment option for COVID-19. This study aimed to provide evidence for the efficacy and safety of this therapy and may contribute to its future use in treating severe cases of COVID-19.
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Affiliation(s)
- Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Katsuyuki Shiratori
- Laboratory Testing Department, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Kenji Maeda
- Division of Antiviral Therapy Joint Research Center for Human Retrovirus Infection, Kagoshima University, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroshi Ohtsu
- Faculty of Health Data Science, Juntendo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross, Tatsumi, Koto-ku, Tokyo 135-8521, Japan
| | - Hiroaki Mitsuya
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
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Kamo-Imai A, Togano T, Sato M, Kawakami Y, Inaba K, Shimazu H, Igarashi S, Tanaka K, Terada M, Kinoshita-Iwamoto N, Saito S, Kutsuna S, Hangaishi A, Morioka S, Takahashi K, Miyata S, Ohmagari N. The safety of plasma apheresis from donors recovering from COVID-19 infection in Japan. Transfus Apher Sci 2023:103687. [PMID: 36964059 PMCID: PMC10027293 DOI: 10.1016/j.transci.2023.103687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Since 2020, the novel coronavirus infection (COVID-19) has spread globally. A few studies have investigated the safety of COVID-19 convalescent plasma (CCP) apheresis from COVID-19. This study was the first retrospective observational study of CCP in Japan. METHODS We recruit donors from April 2020 to November 2021 and plasmapheresis in our center (NCGM: national center for global health and medicine). We set the primary endpoint as the Donors Adverse Event (DAE) occurrence at the time of the CCP collection. Variable selection was used to explore the determinants of DAE. RESULTS Mean and SD age was 50.5 (10.6) years old. Seventy-three (42.2 %) were female, and 87 (33.3 %) were multiple-times donors. Twelve (6.97 % by donors and 4.6 % in total collections) adverse events occurred. The DAEs were VVR (Vaso Vagal Reaction), paresthesia, hypotension, agitation, dizziness, malaise, and hearing impairment/paresthesia. Half of them were VVR during apheresis. DAE occurred only in first-time donors and more in severe illnesses such as using ventilation and ECMO. From the donor characteristics and variable selection, the risk factors are as follows: younger age, female, the severity of disease at the time of the disease, and lower SBP before initiation. Our DAE incidence did not differ from previous studies. DAEs were more likely to occur in CCP apheresis than in healthy donors. CONCLUSION We confirm the safety of CCP apheresis in this study, although DAEs were more than healthy donors. More caution should be exercised in the plasma collection for future outbreaks of emerging infectious diseases.
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Affiliation(s)
- Ayumi Kamo-Imai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Tomiteru Togano
- Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
| | - Motohiko Sato
- Department of Clinical Engineering, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuiko Kawakami
- Department of Clinical Engineering, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kumi Inaba
- Department of Clinical Engineering, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Shimazu
- Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Saori Igarashi
- Department of Nursing, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiko Tanaka
- Department of Nursing, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Department of Infection Control, Graduate School of Medicine, Osaka University, Japan
| | - Akira Hangaishi
- Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenzo Takahashi
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Takamatsu Y, Omata K, Shimizu Y, Kinoshita-Iwamoto N, Terada M, Suzuki T, Morioka S, Uemura Y, Ohmagari N, Maeda K, Mitsuya H. SARS-CoV-2-Neutralizing Humoral IgA Response Occurs Earlier but Is Modest and Diminishes Faster than IgG Response. Microbiol Spectr 2022; 10:e0271622. [PMID: 36219096 PMCID: PMC9769934 DOI: 10.1128/spectrum.02716-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 01/09/2023] Open
Abstract
Secretory immunoglobulin A (IgA) plays a crucial role in mucosal immunity for preventing the invasion of exogenous antigens; however, little is understood about the neutralizing activity of serum IgA. Here, to examine the role of IgA antibodies against COVID-19 illnesses, we determined the neutralizing activity of serum/plasma IgG and IgA purified from previously SARS-CoV-2-infected and COVID-19 mRNA vaccine-receiving individuals. We found that serum/plasma IgA possesses substantial but rather modest neutralizing activity against SARS-CoV-2 compared to IgG with no significant correlation with the disease severity. Neutralizing IgA and IgG antibodies achieved the greatest activity at approximately 25 and 35 days after symptom onset, respectively. However, neutralizing IgA activity quickly diminished to below the detection limit approximately 70 days after onset, while substantial IgG activity was observed until 200 days after onset. The total neutralizing activity in sera/plasmas of those with COVID-19 largely correlated with those in purified IgG and purified IgA and levels of anti-SARS-CoV-2-S1-binding IgG and anti-SARS-CoV-2-S1-binding IgA. In individuals who were previously infected with SARS-CoV-2 but had no detectable neutralizing IgA activity, a single dose of BNT162b2 or mRNA-1273 elicited potent serum/plasma-neutralizing IgA activity, but the second dose did not further strengthen the neutralization antibody response. The present data show that the systemic immune stimulation with natural infection and COVID-19 mRNA-vaccines elicits both SARS-CoV-2-specific neutralizing IgG and IgA responses in serum, but the IgA response is modest and diminishes faster than the IgG response. IMPORTANCE Secretory dimeric immunoglobulin A (IgA) plays an important role in preventing the invasion of foreign objects by its neutralizing activity on mucosal surfaces, while monomeric serum IgA is thought to relate to the phagocytic immune system activation. Here, we report that individuals with the novel coronavirus disease (COVID-19) developed both systemic neutralizing IgG (nIgG) and IgA (nIgA) active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the nIgA response was quick and reached the highest activity earlier than the nIgG response, nIgA activity was modest and diminished faster than nIgG activity. In individuals who recovered from COVID-19 but had no detectable nIgA activity, a single dose of COVID-19 mRNA vaccine elicited potent nIgA activity, but the second dose did not further strengthen the antibody response. Our study provides novel insights into the role and the kinetics of serum nIgA against the pathogen in both naturally infected and COVID-19 mRNA vaccine-receiving COVID-19-convalescent individuals.
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Affiliation(s)
- Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Kazumi Omata
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
- Experimental Retrovirology Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Clinical Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
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4
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Takamatsu Y, Omata K, Shimizu Y, Kinoshita-Iwamoto N, Terada M, Suzuki T, Morioka S, Uemura Y, Ohmagari N, Maeda K, Mitsuya H. SARS-CoV-2-neutralizing humoral IgA response occurs earlier but modest and diminishes faster compared to IgG response. bioRxiv 2022:2022.06.09.495422. [PMID: 35702154 PMCID: PMC9196114 DOI: 10.1101/2022.06.09.495422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Secretory immunoglobulin A (IgA) plays a crucial role in the mucosal immunity for preventing the invasion of the exogenous antigens, however, little has been understood about the neutralizing activity of serum IgA. Here, to examine the role of IgA antibodies against COVID-19 illnesses, we determined the neutralizing activity of serum/plasma IgG and IgA purified from previously SARS-CoV-2-infected and COVID-19 mRNA-vaccine-receiving individuals. We found that serum/plasma IgA possesses substantial but rather modest neutralizing activity against SARS-CoV-2 compared to IgG with no significant correlation with the disease severity. Neutralizing IgA and IgG antibodies achieved the greatest activity at approximately 25 and 35 days after symptom onset, respectively. However, neutralizing IgA activity quickly diminished and went down below the detection limit approximately 70 days after onset, while substantial IgG activity was observed till 200 days after onset. The total neutralizing activity in sera/plasmas of those with COVID-19 largely correlated with that in purified-IgG and purified-IgA and levels of anti-SARS-CoV-2-S1-binding IgG and anti-SARS-CoV-2-S1-binding IgA. In individuals who were previously infected with SARS-CoV-2 but had no detectable neutralizing IgA activity, a single dose of BNT162b2 or mRNA-1273 elicited potent serum/plasma neutralizing IgA activity but the second dose did not further strengthen the neutralization antibody response. The present data show that the systemic immune stimulation with natural infection and COVID-19 mRNA-vaccines elicit both SARS-CoV-2-specific neutralizing IgG and IgA response in serum, but the IgA response is modest and diminishes faster compared to IgG response. Author Summary Immunoglobulin A (IgA) is the most abundant type of antibody in the body mostly located on mucosal surfaces as a dimeric secretory IgA. Such secretory IgA plays an important role in preventing the adherence and invasions of foreign objects by its neutralizing activity, while monomeric serum IgA is thought to relate to the phagocytic immune system activation. Here, we report that individuals with the novel coronavirus disease (COVID-19) developed both systemic neutralizing IgG and IgA active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the neutralizing IgA response was quick and reached the highest activity 25 days post-symptom-onset, compared to 35 days for IgG response, neutralizing IgA activity was modest and diminished faster than neutralizing IgG response. In individuals, who recovered from COVID-19 but had no detectable neutralizing IgA activity, a single dose of COVID-19 mRNA-vaccine elicited potent neutralizing IgA activity but the second dose did not further strengthen the antibody response. Our study provides novel insights into the role and the kinetics of serum IgA against the viral pathogen both in naturally-infected and COVID-19 mRNA-vaccine-receiving COVID-19-convalescent individuals.
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Affiliation(s)
- Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute
| | - Kazumi Omata
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine
| | - Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine;,Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine
| | - Shinichiro Morioka
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute;,Experimental Retrovirology Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health;,Department of Clinical Sciences, Kumamoto University School of Medicine
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5
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Suzuki T, Asai Y, Ide S, Fukuda S, Tanaka A, Shimanishi Y, Takahashi K, Terada M, Sato L, Sato M, Inada M, Yamada G, Miyazato Y, Akiyama Y, Nomoto H, Nakamoto T, Nakamura K, Togano T, Morioka S, Kinoshita-Iwamoto N, Saito S, Kutsuna S, Ohmagari N. Factors associated with high antibody titer following coronavirus disease among 581 convalescent plasma donors: A single-center cross-sectional study in Japan. J Infect Chemother 2021; 28:206-210. [PMID: 34756573 PMCID: PMC8526427 DOI: 10.1016/j.jiac.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022]
Abstract
Introduction The ability to predict which patients with a history of coronavirus disease (COVID-19) will exhibit a high antibody titer is necessary for more efficient screening of potential convalescent plasma donors. We aimed to identify factors associated with a high immunoglobulin G (IgG) titer in Japanese convalescent plasma donors after COVID-19. Methods This cross-sectional study included volunteers undergoing screening for convalescent plasma donation after COVID-19. Serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) S-protein IgG antibodies were measured using a high-sensitivity chemiluminescence enzyme immunoassay. Results IgG antibodies were measured in 581 patients, 534 of whom had full information of selected independent variables. Multiple linear regression analysis revealed that increasing age (1.037 [1,025, 1.048]), days from symptom onset to sampling (0.997 [0.995, 0.998]), fever (1.664 [1.226, 2.259]), systemic corticosteroid use during SARS-CoV-2 infection (2.382 [1.576, 3.601]), and blood type AB (1.478 [1.032, 2.117]) predict antibody titer. Conclusion Older participants, those who experienced fever during infection, those treated with systemic corticosteroids during infection, those from whom samples were obtained earlier after symptom onset, and those with blood type AB are the best candidates for convalescent plasma donation. Therefore, these factors should be incorporated into the screening criteria for convalescent plasma donation after SARS-CoV-2 infection.
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Affiliation(s)
- Tetsuya Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Ide
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Saori Fukuda
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akihito Tanaka
- Clinical Laboratory Department, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yumiko Shimanishi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kozue Takahashi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiro Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Makoto Inada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaro Akiyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takato Nakamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiji Nakamura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infection Control, Graduate School of Medicine, Osaka University, Japan.
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
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Hara H, Uemura Y, Hayakawa K, Togano T, Asai Y, Matsunaga N, Terada M, Ohtsu H, Kitajima K, Shimizu Y, Sato L, Ishikane M, Kinoshita-Iwamoto N, Shibata T, Kondo M, Izumi K, Sugiura W, Ohmagari N. Evaluation of the efficacy of anticoagulation therapy in reducing mortality in a nationwide cohort of hospitalized patients with coronavirus disease in Japan. Int J Infect Dis 2021; 112:111-116. [PMID: 34517044 PMCID: PMC8432973 DOI: 10.1016/j.ijid.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To determine whether anticoagulation therapy improves outcomes in patients with coronavirus disease 2019 (COVID-19) in Japan given their lower risk of thrombosis compared with Western cohorts. Methods The efficacy of anticoagulation therapy in hospitalized patients with COVID-19 was evaluated using a nationwide registry: the COVID-19 Registry Japan. The inverse probability of weight treatment method was used to adjust for baseline confounders in the anticoagulation and non-anticoagulation groups. Results Of the 1748 patients included, anticoagulants were used in 367 patients (treatment group). The patients in the anticoagulant group were older, predominantly male, and often presented with obesity, hyperlipidaemia, hypertension, diabetes and elevated D-dimer levels. Twenty-nine-day mortality was 7.6% in the whole cohort (treatment group, 11.2%; no treatment group, 6.6%), 6% in patients who were not treated with steroids (treatment group, 12.3%; no treatment group, 5.2%), and 11.2% in patients treated with steroids (treatment group, 10.5%; no treatment group, 11.8%). Mortality in the whole cohort was similar between the treatment and no treatment groups (P=0.99), and an insignificant decreasing trend in mortality was observed in patients treated with steroids (P=0.075). Conclusions Anticoagulants may be beneficial in Asians, in whom comorbidities and risk of thrombosis may differ from other ethnic groups.
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Affiliation(s)
- Hisao Hara
- Department of Cardiology, National Centre for Global Health and Medicine, Tokyo, Japan.
| | - Yukari Uemura
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Tomiteru Togano
- Department of Haematology, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Mari Terada
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan; Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Ohtsu
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Koji Kitajima
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Yousuke Shimizu
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Lubna Sato
- Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Centre, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Division, Centre for Research Administration and Support, National Cancer Centre, Tokyo, Japan
| | - Masashi Kondo
- Centre for Clinical Trial and Research Support, Fujita Health University, Aichi, Japan
| | - Kazuo Izumi
- Biostatistics Section, Centre for Clinical Sciences, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Wataru Sugiura
- Biostatistics Division, Centre for Research Administration and Support, National Cancer Centre, Tokyo, Japan
| | - Norio Ohmagari
- Department of Haematology, National Centre for Global Health and Medicine, Tokyo, Japan; Biostatistics Division, Centre for Research Administration and Support, National Cancer Centre, Tokyo, Japan
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