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Published on: June 5, 2021
Randomized controlled trial transfusing convalescent plasma as post-exposure prophylaxis against SARS-CoV-2 infection
Shmuel Shoham1, Evan M Bloch1, Arturo Casadevall1
1Department of Medicine (S.S., K.G., D.T., P.B., J.Z., A.B., L.A., C.M.) Department of Pathology (E.B., A.T.), Department of Neurology (K.L., N.M., D.H., A.G., A.Y.) and the Department of Ophthalmology (DJ), The Johns Hopkins University School of Medicine, Baltimore, MD, Departments of Molecular Microbiology and Immunology (A.C., D.S., S.K., H.S.P., C.A.C., J.R.S., A.P. A.J.) and Epidemiology (B.L., D.S., D.J., S.E.,S.B., C.S.) The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Mosaic Consulting Ltd., Israel (N.K.), Department of Medicine, Luminis Health, Annapolis, MD (B.M.), Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX (Y.F), Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI (A.L.), Division of Infectious Diseases/Department of Medicine, Georgetown University Medical Center, Washington, DC (S.K.), Division of Allergy and Immunology, Department of Medicine (G.M.), and Department of Pathology (T.G.), Northshore University Health System, Evanston, IL, Department of Medicine, Division of Infectious Diseases University of Cincinnati, Cincinnati, OH (M.H.), Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, CA (D.F.), Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA (J.S.), Department of Medicine, Division of Infectious Diseases (E.C.) and Department of Pathology (E.A.), University of California, San Diego, San Diego, CA, Department of Medicine, Division of Hematology and Oncology, University of Massachusetts, Worchester, MA (J.G.), Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL (SA), Department of Medicine, University of Rochester, Rochester, NY (MZ), Department of Neurology, University of Utah, Salt Lake City, UT (J.R.S), Department of Medicine, Division Critical Care Medicine, University of Texas Health, Houston, TX (B.P.), Department of Emergency Medicine Wayne State University, Detroit, MI (J.P.), Danbury Hospital (P.B.), Norwalk Hospital (J.H.), Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, NY (VC) and University of Vermont (J.P., W.R., M.E.C.), Nuvance Health, Danbury, CT, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health Baltimore, MD (O.L.).
High-titer SARS-CoV-2 convalescent plasma (CCP) was evaluated as post-exposure prophylaxis in individuals exposed to COVID-19. This study found that CCP did not prevent SARS-CoV-2 infection but was safe for use.
Area of Science:
- Infectious Diseases
- Immunology
- Clinical Trials
Background:
- The effectiveness of SARS-CoV-2 convalescent plasma (CCP) in preventing infection among exposed individuals remains undetermined.
- This study investigated CCP as a prophylactic measure against SARS-CoV-2 infection following close contact exposure.
Approach:
- A double-blinded, randomized controlled trial (RCT) compared high-titer CCP (≥1:320) with standard plasma for post-exposure prophylaxis.
- Eligible participants were asymptomatic adults with recent exposure to confirmed COVID-19 and negative SARS-CoV-2 tests prior to transfusion.
- The primary endpoint was the development of SARS-CoV-2 infection.
Key Points:
- 180 participants were enrolled, with 168 analyzed post-transfusion.
- SARS-CoV-2 infection occurred in 14.8% of CCP recipients and 14.9% of control recipients.
- COVID-19 developed in 7.4% of CCP recipients and 8% of control recipients, with no significant difference in infection rates or time to infection.
Conclusions:
- High-titer CCP administered as post-exposure prophylaxis is safe for individuals recently exposed to SARS-CoV-2.
- CCP did not demonstrate efficacy in preventing SARS-CoV-2 infection or symptomatic COVID-19 in this trial.
- Further research may be needed to explore alternative strategies for preventing COVID-19 in high-risk populations.

