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

  • Xuanguo ZHANG Intensive Care Unit, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, China
  • Li XI Editorial Department of Shaanxi Journal of Traditional Chinese Medicine, Shaanxi Academy of Traditional Chinese Medicine, Xi'an, 710003, China
  • Fang PANG College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, 400016, China
  • Yan DU Graduate School, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
  • Qiuzhen YUAN Department of Pharmacy, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, China
  • Minjuan SHI Department of Pharmacy, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, China
  • Jiping LIU Department of Pharmacology, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
  • Hui MA Department of Healthcare-Associated Infection Control, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, China
  • Bo LI Mail Department of Pharmacy, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, China
Keywords:
Coronavirus disease (COVID-19), SARS-CoV-2;, Convalescent plasma, Pneumonia

Abstract

Background: COVID-19 is a public health emergency of international concern. Its incidence rates and mortality are very high; however, so far, an effective drug treatment remains unknown. Based on the role of convalescent plasma therapy in previously identified viral pneumonias, patients with severe COVID-19 have been given this therapy. This systematic review and meta-analysis aimed to summarize the clinical evidence regarding the efficacy and safety of convalescent plasma therapy in the treatment of severe COVID-19.

Methods: PubMed, Embase, Ovid, China Knowledge Network, China Biomedical, VIP Chinese Sci-tech Journal, Wanfang Database, and the International Clinical Trials Registry Platform were searched up to 21 June 2020, to identify clinical studies and registered trials on the use of convalescent plasma in the treatment of critically ill patients with COVID-19. Stata 13.0 was used to perform Meta-analysis. All records were screened as per the protocol eligibility criteria.

Results: Nineteen clinical reports regarding convalescent plasma in the treatment of severe COVID-19 were included. Through systematic analysis, convalescent plasma was found to yield some efficacy on severe COVID-19 and had almost no obvious adverse reactions.

Conclusion: Convalescent plasma therapy seems to yield some efficacy among patients with severe COVID-19 and almost no obvious adverse reactions were found. However, at present, the clinical evidence is insufficient, and there is an urgent need for support from high-quality clinical trial data.

References

1. Helmy YA, Fawzy M, Elaswad A, et al (2020). The COVID-19 Pandemic: A Comprehensive Review of Taxonomy, Genetics, Epidemiology, Diagnosis, Treatment, and Control. J Clin Med, 9(4):1225.
2. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al (2015). The effectiveness of con-valescent plasma and hyperimmune im-munoglobulin for the treatment of severe acute respiratory infections of viral etiolo-gy: a systematic review and exploratory meta-analysis. J Infect Dis,211(1):80-90.
3. Ko JH, Seok H, Cho SY, et al (2018). Chal-lenges of convalescent plasma infusion therapy in Middle East respiratory coro-navirus infection: A single centre experi-ence. Antivir Ther,23(7):617-622.
4. Ying Li, Shuchao Zhang, Shaoqiang Zhang, et al (2020). Treatment with convalescent plasma for one covid-19 patient. Journal of Clinical Transfusion and Laboratory Medicine. Available from: http://kns.cnki.net/kcms/detail/34.1239.R.20200415.1851.002.html
5. Kai Duan, Bende Liu, Cesheng Li, et al (2020). Effectiveness of convalescent plasma therapy in severe covid-19 pa-tients. Proc Natl Acad Sci U S A, 117(17):9490-96.
6. Chenguang Shen, Zhaoqin Wang, Fang Zhao, et al (2020). Treatment of 5 critical-ly ill patients with covid-19 with convales-cent plasma. JAMA, 323(16):1582-1589.
7. Bin Zhaing, Shuyi Liu, Tan Tan, et al (2020). Treatment with convalescent plasma for critically ill patients with severe acute res-piratory syndrome coronavirus 2 infec-tion. Chest, 158(1): e9-e13
8. Ahn JY, Sohn Y, Lee SH, et al (2020). Use of convalescent plasma therapy in two COVID-19 patients with acute respirato-ry distress syndrome in Korea. J Korean Med Sci, 35(14): e149.
9. Mingxiang Ye, Dian Fu, Yi Ren, et al (2020). Treatment with convalescent plasma for COVID-19 patients in Wuhan, China. J Med Virol, 10.1002/jmv.25882.
10. Libo Zhang, Rongrong Pang, Xiang Xue, et al (2020). Anti-SARS-CoV-2 virus anti-body levels in convalescent plasma of six donors who have recovered from COVID-19. Aging (Albany NY), 12(8):6536–6542.
11. Qinglei Zeng, Zujiang Yu, Jianjun Gou, et al (2020). Effect of convalescent plasma therapy on viral shedding and survival in patients with coronavirus disease 2019. J Infect Dis, 222(1):38–43.
12. Jingtao Dai, Ma Zhuo, Aiqi Xi, et al (2020). Treatment experience of three covid-19 cases in the fourth people's hospital of qinghai province. Chinese High Altitude Medicine and Biology, 41:19-21.
13. Anderson J, Schauer J, Bryant S, et al (2020). The use of convalescent plasma therapy and remdesivir in the successful man-agement of a critically ill obstetric patient with novel coronavirus 2019 infection: A case report. Case Rep Womens Health, 27: e00221.
14. Salazar E, Perez KK, Ashraf M, et al (2020). Treatment of coronavirus disease 2019 (COVID-19) patients with convalescent plasma. Am J Pathol, 190(8):1680–1690.
15. Ling Li, Wei Zhang, Yu Hu, et al (2020). Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening covid-19. JAMA, 324(5): 1–11.
16. Yinglong Ma, Zhenggui Yang, Qiang Ye, et al (2020). Effect of plasma treatment novel coronavirus pneumonia in critically ill patients in ningxia designated hospital. Ningxia Medical Journal, 42(4):356-357.
17. Yujie Kong, Chen Cai, Li Ling, et al (2020). Successful treatment of a centenarian with coronavirus disease 2019 (COVID-19) using convalescent plasma. Transfus Apher Sci, 102820. Available from: https://doi.org/10.1016/j.transci.2020.102820
18. Joyner M, Wright RS, Fairweather D, et al (2020). Early safety indicators of covid-19 convalescent plasma in 5,000 patients. Preprint. medRxiv, doi: 10.1101/2020.05.12.20099879.
19. Çınar, O. E, Sayınalp B, Aladağ Karakulak, E, et al (2020). Convalescent (immune) plasma treatment in a myelodysplastic COVID-19 patient with disseminated tu-berculosis. Transfus Apher Sci. Available from: https://doi.org/10.1016/j.transci.2020.102821
20. Hegerova L, Gooley TA, Sweerus KA, et al (2020). Use of convalescent plasma in hospitalized patients with COVID-19: case series. Blood, 136(6): 759–762.
21. Tianmin Xu, Bin Lin, Cong Chen, et al (2020). Non-optimal effectiveness of convalescent plasma transfusion and hy-droxychloroquine in treating COVID-19: a case report. Virol J, 17: 80.
22. Kun Xiao, Yang Lin, Zhifang Fan, et al (2020). Effect of transfusion convalescent recovery plasma in patients with corona-virus disease 2019. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 45(5):565-570.
23. Epstein J, Burnouf T (2020). Points to con-sider in the preparation and transfusion of COVID-19 convalescent plasma. Vox Sang, Available from: https://doi.org/10.1111/vox.12939
24. National Health Commission of China (2020). COVID-19 diagnosis and treat-ment plan (trial fourth edition) (EB/OL) (2020-01-27) (2020-05-06). National Health Commission. http://www.nhc.gov.cn/yzygj/s7653p/202001/4294563ed35b43209b31739bd0785e67/files/7a9309111267475a99d4306962c8bf78.pdf
25. National Health Commission of China (2020). COVID-19 diagnosis and treat-ment plan (trial fifth edition) (EB/OL) (2020-02-05) (2020-05-06). National Health Commission. http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440/files/7260301a393845fc87fcf6dd52965ecb.pdf
26. National Health Commission of China (2020). COVID-19 diagnosis and treat-ment plan (trial sixth edition) (EB/OL) (2020-02-19) (2020-05-06). National Health Commission. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2/files/b218cfeb1bc54639af227f922bf6b817.pdf
27. National Health Commission of China (2020). COVID-19 diagnosis and treat-ment plan (trial seventh edition) (EB/OL).2020-03-04) (2020-05-06). Na-tional Health Commission. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf
28. National Health Commission of China (2020). COVID-19 convalescent plasma clinical treatment plan (trial second edi-tion). National Health Commission. http://www.nhc.gov.cn/yzygj/s7653p/202004/c083f2b0e7eb4036a59be419374ea89a/files/0f4be6a0f4f0419cae3ab6b6efd7cead.pdf
29. National Health Commission of China (2020). Further strengthen the work plan for plasma treatment of convalescent covid-19 patients (EB/OL). (2020-02-28)(2020-05-06). National Health Com-mission Web; Available from: http://www.nhc.gov.cn/yzygj/s7658/202002/9cf3cdf8d1fb480e9d6d05cbda0c6a5f.shtml
30. National Health Commission of China (2020). COVID-19's diagnosis and treatment plan for severe and critical cas-es (trial second edition). (2020-03-04) (2020-05-06). National Health Commis-sion. http://www.nhc.gov.cn/yzygj/s7658/202003/61d608a7e8bf49fca418a6074c2bf5a2/files/a5e00234915344c6867a3e6bcfac11b7.pdf
31. Food and Drug Administration (2020). Coronavirus (COVID-19) update: Daily roundup. (2020-03-24) (2020-05-06). Food and drug administration. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-daily-roundup-march-24-2020
32. National Institutes of Health (2020). COVID -19 is an emerging, rapidly evolving situation. National Institutes of Health. Available from: https://www.covid19treatmentguidelines.nih.gov/critical-care/pharmacologic-interventions/
33. Bloch EM, Shoham S, Casadevall A, et al (2020). Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest, 130(6): 2757–2765.
34. Franchini M, Marano G, Velati C, et al (2020). Operational protocol for dona-tion of anti-COVID-19 convalescent plasma in Italy. Vox Sang. Advance online publication. https://doi.org/10.1111/vox.12940
Published
2020-10-27
How to Cite
1.
ZHANG X, XI L, PANG F, DU Y, YUAN Q, SHI M, LIU J, MA H, LI B. Convalescent Plasma in the Treatment of Severe COVID-19: A Systematic Review and Meta-Analysis. Iran J Public Health. 49(11):2022-2031.
Section
Review Article(s)