Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma
clinical immunology/immunity therapeutics
Authors: Shen et al. Link to paper: https://jamanetwork.com/journals/jama/fullarticle/2763983
Journal/ Pre-Print: JAMA Network
Key Words: Convalescent Plasma, Treatment, Clinical Research
1. Reporting of a convalescent antibody treatment of five critically-ill patients with COVID19
2. Convalescent treatment among these five cases did not seem to have negative health effects
3. Study fails to show definite proof of effectiveness of convalescent antibody treatment
This study reports the cases of five critically-ill patient positive for COVID19, who have been treated with convalescent antibody plasma. The authors describe that clinical symptoms of all five patients improved post-transfusion over a 12-day time period: (1) improved clinical parameters, (2) increased oxygen saturation, (3) decreased viral titres, (4) decreased multiorgan failure scores. However, all of the patients were simultaneously treated with several anti-viral drugs and the start of treatment after admission varied between patients groups. The most notable effect observed was the relatively quick decrease of viral titre after convalescent plasma treatment. Unfortunately, the study design did not allow a definite statement about the effectiveness of convalescent antibody treatment, acknowledge by the authors .
IMPACT FOR SARS-COV2/COVID19 RESEARCH EFFORTS
· Treatment of SARS-CoV2/COVID19 positive individuals
Using convalescent antibody plasma from recovered COVID19 patients presents a promising strategy to treat patients with ongoing SARS-CoV2 infections in the absence of a functional antiviral treatment or vaccine.
· Clinical Cohort study (e.g. drug trials)
· Patient Case study
STRENGTHS AND LIMITATIONS OF THE PAPER
Standing in the field: Convalescent antibody treatment for SARS-CoV2 is currently being heavily debated and several controlled studies were started in Germany, the US and elsewhere. The effectiveness of this treatment remains to be evaluated. The safety of this type of treatment was recently corroborated by Duan et al. (2020, PNAS).
Appropriate statistics: No statistical test were applied
Viral model used: Patients with qPCR-positive SARS-CoV2 in intensive care
Translatability: High translational potential if it works in a well-controlled clinical
· The study was not controlled and this makes interpretation of the effectiveness of the treatment unclear. Patients’ symptoms could have improved on their own or due to the other drugs they were taking. · The convalescent plasma input was not normalized to the antibody concentration found in the plasma of different recipients.
· the status of the endogenous immune response prior and post convalescent antibody treatment is unclear (e.g. evaluation of IgG plasma cells).
· Unclear if patient 1 and 2 (the only patients suffering from bacterial pneumonia) were on antibiotics throughout the treatment