COVID-19: convalescent plasma shows little benefit in severe illness

  • Simonovich VA & al.
  • N Engl J Med
  • 24.11.2020

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • Convalescent plasma plus standard care yields no reduction in 30-day mortality or other outcomes in severe COVID-19 pneumonia.

Why this matters

  • Convalescent plasma treatment in severely ill patients with COVID-19 may need re-evaluation.

Key results

  • 228 patients received convalescent plasma and 105 a placebo treatment. 
  • Median age: 62 (interquartile range [IQR], 52-72) years.
  • Median time, symptom onset to enrollment: 8 (IQR, 5-10) days.
    • Most had hypoxia.
  • Infused convalescent plasma median titer: 1:3200 (IQR, 1:800-1:3200) total SARS-CoV-2 antibodies.
  • At day 30: 
    • No significant difference in clinical outcomes (ordinal scale): OR, 0.83 (P=.46).
    • Mortality: 10.96% convalescent plasma vs 11.43% placebo.
    • Risk difference: −0.46 (95% CI, −7.8 to 6.8) percentage points.
  • Median time to hospital discharge: 13 (IQR, 8-30) days with convalescent plasma vs 12 (IQR, 7-30) days with placebo. 
  • ICU admission: 53.9% receiving convalescent plasma vs 60% receiving placebo.
  • Ventilatory support: 26.8% convalescent plasma vs 22.9% placebo. 
  • No significant differences in overall (OR, 1.21; 95% CI, 0.74-1.95) or serious adverse events (1.40; 0.78-2.51).

Study design

  • Double-blind, placebo-controlled, multicenter study assessing convalescent plasma treatment vs placebo in patients hospitalized with severe COVID-19 pneumonia in Argentina.
  • Funding: No external funding.

Limitations

  • Limited generalizability.
  • Inability to measure earlier treatment effect.
  • Missing confounders.