Plasma of recovered patients can help treat severe coronavirus cases


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A new report raises hope that the blood of recovered patients can help treat severe coronavirus cases.

Five critically ill patients were hospitalized in Shenzhen, China, with serious cases of COVID-19. They received an experimental plasma transfusion and have since recovered to varying degrees, according to new research published 27 March 2020 in the Journal of the American Medical Association.

Doctors conducted the study at a Shenzhen hospital from January 20 to March 25. The five patients, ranging in age from 36 to 73, received plasma between 10 and 22 days after being admitted to the hospital.

Within three days of the transfusion, four of the five had their body temperature normalize. Four of the five also saw their cases of acute respiratory distress resolve within 12 days.

All told, by the time the results were published Friday, three of the patients had been discharged from the hospital. The other two were both in stable condition, but still needed to be on ventilators in a hospital setting.

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

Chenguang Shen, PhD1Zhaoqin Wang, PhD1Fang Zhao, PhD1et alYang Yang, MD1Jinxiu Li, MD1Jing Yuan, MD1Fuxiang Wang, MD1Delin Li, PhD1,2Minghui Yang, PhD1Li Xing, MM1Jinli Wei, MM1Haixia Xiao, PhD1,2Yan Yang, MM1Jiuxin Qu, MD1Ling Qing, MM1Li Chen, MD1Zhixiang Xu, MM1Ling Peng, MM1Yanjie Li, MM1Haixia Zheng, MM1Feng Chen, MM1Kun Huang, MM1Yujing Jiang, MM1Dongjing Liu, MD1Zheng Zhang, MD1Yingxia Liu, MD1Lei Liu, MD1

JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4783

Key Points

Question  Could administration of convalescent plasma transfusion be beneficial in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19)?

Findings  In this uncontrolled case series of 5 critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status.

Meaning  These preliminary findings raise the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but this approach requires evaluation in randomized clinical trials.Abstract

Importance  Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

Objective  To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design, Setting, and Participants  Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation. All 5 were treated with convalescent plasma transfusion. The study was conducted at the infectious disease department, Shenzhen Third People’s Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020. Clinical outcomes were compared before and after convalescent plasma transfusion.

Exposures  Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody (IgG) binding titer greater than 1:1000 (end point dilution titer, by enzyme-linked immunosorbent assay [ELISA]) and a neutralization titer greater than 40 (end point dilution titer) that had been obtained from 5 patients who recovered from COVID-19. Convalescent plasma was administered between 10 and 22 days after admission.

Main Outcomes and Measures  Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion.

Results  All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

Conclusions and Relevance  In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

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