May 6, 2020
Convalescent Plasma for Critically Ill Patients with COVID-19 Reviewed by Milana Bogorodskaya, M.D.
In a recent study published in JAMA, Shen et al. describe a case series of five patients who received convalescent plasma as therapy for severe COVID-19 infection. All patients had severe pneumonia with PaO2/FiO2 < 300, were on mechanical ventilation, and had persistently high SARS-CoV-2 viral loads despite antiviral and corticosteroid therapy. Three of the patients were male and two were female, ranging between 30-80 years of age. Only one patient had any coexisting comorbid conditions (hypertension and mitral valve insufficiency). The average interval between admission and receipt of convalescent plasma was 18 days. All five patients received antiviral therapy and corticosteroids prior to the administration of convalescent plasma; the initiation and duration of these therapies in relation to convalescent plasma administration is not known. The plasma was obtained from individuals who had recovered from confirmed COVID-19 infection and had confirmed antibody titers to the virus.
The results demonstrated that all five patients achieved a negative viral load test at day 12 post-administration of convalescent plasma, as well as decrease in temperature, C-reactive protein, oxygen requirements, and SOFA scores. Four out of five had decreased IL-6 levels at day 12. Three out of five were extubated at day 12 post-administration and were clinically improving. The remaining two patients remained stable. All five patients had increased IgM, IgG, and neutralizing antibody titers post-administration of convalescent plasma, however clinical outcomes did not appear to correlate with either absolute titer values or the interval increase in antibody titers.
There are multiple limitations to this study, including the lack of a control group, prior administration of other therapies that may have confounded the results, and the lack of information regarding the timing of other therapies as well as average time of follow-up beyond 12 days. Nevertheless, this small case-series demonstrates the safety and feasibility of convalescent plasma administration and prompts further investigation of plasma as a potential therapeutic intervention against COVID-19 infection.
