Three years into the COVID-19 pandemic, new variant outbreaks continue to fuel economic disruption and hospitalizations around the world. Effective remedies remain unavailable in much of the world and circulating variants have rendered monoclonal antibody remedies ineffective. But new research shows how convalescent plasma can be used as an effective and affordable remedy in both the COVID-19 pandemic and the inevitable pandemics of the future.
In a paper published in Clinical Infectious Diseases, a foreign team of researchers analyzed clinical knowledge and concluded that in outpatients with COVID-19, antibodies to SARS-CoV-2 given early and at peak doses reduced the threat of hospitalization.
If the effects of this meta-analysis had somehow occurred in March 2020, then I am confident that millions of lives would have been stored around the world. “
While several other early remedies for COVID-19 have had similar results, by adding antivirals such as Paxlovid and monoclonal antibodies, only convalescent plasma, the researchers concluded, is likely to be available and affordable to the majority of the world’s population, now and at the beginning of the next viral pandemic.
“These findings will be useful for this pandemic, especially in places like China, India and other parts of the world that don’t have antiviral drugs like Paxlovid,” Levine said. “And because it provides data on how to use convalescent plasma more than a therapy, it will be even more useful in the next pandemic. This study is necessarily a roadmap on how to get this right next time.
Blood plasma from others who recovered from COVID-19 and contains antibodies to SARS-CoV-2 was used as a remedy early in the pandemic, Levine said; months before vaccines or monoclonal antibody cures are available, and more than a year before an effective cure with oral medications is clinically available.
Although convalescent plasma looked promising, outpatient studies were limited and existing studies showed combined results. One challenge was that most of the studies were conducted on patients who were already hospitalized with COVID-19, Levine said, largely because of the convenience of conducting studies with this population. The aim of the new study was to read about all available randomised controlled trials of convalescent plasma in out-of-hospital adults with COVID-19 to determine whether early treatment can reduce the risk of hospitalisation.
The research included knowledge of five studies conducted in 4 countries, plus Argentina, the Netherlands, Spain and two in the United States. In the past, Levine oversaw enrollment at Rhode Island Hospital in a clinical trial led by Johns Hopkins Medicine and Johns Hopkins Bloomberg School. In the five studies, a total of 2620 adult patients received convalescent plasma transfusions from January 2020 to September 2022. The researchers conducted a meta-investigation of knowledge of individual players to assess the effect of transfusion timing and dose on the patient’s threat of hospitalization during the 28 days following infection.
In their analysis, the researchers found that 160 (12. 2%) of the 1315 patients were hospitalized compared to 111 (8. 5%) of the 1305 patients treated with COVID-19 convalescent plasma; 30% fewer hospitalizations.
In particular, the most potent effects were noted in patients treated either early in the disease and with plasma with high degrees of antibodies. In those patients, the relief of hospitalizations exceeded 50%.
For long-term pandemics, the purpose is to use plasma from donors who have the highest levels of antibodies, Dr. David J. said. Sullivan, professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health and Public Health. Faculty of Medicine. ” This study suggests that we underdose convalescent plasma for many previous pathogens, which affects efficacy,” Sullivan said. “It bears repeating: the first and best grades of antibodies have greater favorable efficacy. “
Levine explained that because convalescent plasma was the only remedy available at the beginning of the pandemic, it was widely used: convalescent plasma was widely used, convalescent plasma was widely used, convalescent plasma, and incorrectly in hospitalized patients who were already experiencing severe past symptoms during the course of COVID-19. These symptoms were due to a higher immune reaction to the virus, not the virus itself, Levine explained.
“By the time the patient at the point where he had reached the inflammatory phase causing severe symptoms, it was too late for remedies like convalescent plasma or even monoclonal antibodies to work,” he said.
What is now known is that convalescent plasma works when given early in the disease. That’s when it can neutralize the virus and get ahead of the framework by creating an intense immune response, preventing hospitalization and death, Levine said.
The five trials of addiction remedies in the research were located in a variety of global health care settings, he noted, adding nursing homes, outpatient clinics and emergency departments. The diversity of studies is a sign that knowledge can probably be generalized to many other types of populations and contexts around the world, said Levine, who also directs the Watson Institute for International and Public Affairs’ Center for Human Rights and Humanitarian Studies in Brun.
Levine cited a study recently published in JAMA Network Open that showed convalescent plasma is effective in reducing mortality in immunocompromised patients. This new meta-analysis provides evidence that convalescent plasma could also be effective in the larger population of adults who are not immunocompromised.
The U. S. Food and Drug Administrationlegalized the early use of convalescent plasma in December 2021 for COVID-19 patients who were also immunosuppressed, but not yet for COVID-19 patients who are not immunosuppressed. The authors said they hoped the new study would prompt the FDA and other countries around the world to make early COVID-19 convalescent plasma remedy for a much broader organization of patients at risk of hospitalization.
The findings come at a time when monoclonal antibodies, the most commonly used remedy for COVID-19, have proven useless against new variants of the virus. In November, the FDA revoked emergency approval of the latest monoclonal antibody remedy because it was not expected. have much opposite effect to the subvariants of Omicron.
Unlike monoclonal antibody therapies, Levine said, convalescent plasma donated through patients who have recovered from the virus is a remedy evolving with the pandemic. Because it has antibodies that attach to several other parts of the virus, there are still opportunities to bind to a receptor even after the virus mutates and transforms some of its receptors. It is also less expensive to produce than pharmaceutical antivirals.
In the first year of the pandemic, Levine said, before effective vaccines and remedies were developed, researchers tried many remedy methods to temporarily locate anything that worked to save lives.
“When the next big pandemic hits, we’ll be in a very similar situation,” Levine said. “However, at least next time, we will have studies like this to tell our strategy. “
Brown University
Levine, AC, et al. (2023) Outpatient treatment of COVID-19 convalescent plasma to prevent outpatient hospitalization: a meta-analysis of individual player knowledge from five randomized trials. Infectious diseases cliniques. doi. org/10. 1093/cid/ciad088.
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