//Convalescent Plasma, Poor results

Convalescent Plasma, Poor results

Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial) (BMJ, 12th October)

https://www.bmj.com/content/371/bmj.m3939

India, 39 public and private hospitals

464 adults admitted with confirmed moderate covid-19

Respiratory rate, more than 24/min

Oxygen saturation 93% or less on room air

Randomisation sequence

Convalescent plasma group (Intervention group)

n = 235

Best standard of care (Control group)

n = 229

Intervention group

Received two doses of 200 mL convalescent plasma

Detectable neutralising antibodies

Outcome measure

Progression to severe disease

All cause mortality at 28 days

Time to symptom resolution

Intervention group

Progression to severe disease death, 44 (19%)

Mortality within 28 days, 34 participants (15%)

Progression to severe disease, 17

Control group

Progression to severe disease death, 41 (18%)

Mortality within 28 days, 31 participants (14%)

Progression to severe disease, 17

Other things the same

Duration of respiratory support

Proportion of receiving invasive ventilation,

Resolution of fever and cough

Oxygen requirement

Organ failure assessment

WHO scale scores for clinical improvement

Average levels of inflammatory markers

Lactate

C reactive protein

D-dimer

Neutralising antibody titres in plasma recipients did not correlate with clinical outcomes

Better in the intervention group

Resolution of shortness of breath and
fatigue at day 7

Patients testing antigen negative at day 7

Also

Among the 38 who received invasive ventilation, only two survived until 28 days

Conclusion

Convalescent plasma was not associated with a reduction in progression to severe covid-19

or all cause mortality

High generalisability

approximates convalescent plasma use in real life settings

Professor Ian Jones, virology, Reading University

The poor performance of convalescent plasma in this trial is disappointing but not entirely surprising

Plasma is more likely to work if given very early

Researchers should to continue to conduct trials
but to do so in newly diagnosed patients.

We still do not have enough treatments for the early stage of disease to prevent severe disease and until this becomes an option, avoiding being infected with the virus remains the key message

Implications
MAB therapy
Long term immunity
Vaccination

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