Early Outpatient Treatment for Covid-19 with Convalescent Plasma

David J Sullivan1, Kelly A Gebo1, Shmuel Shoham1

  • 1From the Department of Medicine, Division of Infectious Diseases (K.A.G., S.S.), the Department of Pathology (E.M.B., C.E.M., A.A.R.T.), the Department of Neurology, Brain Injury Outcomes Division (A.Y., K.L., N.A.M., A.L.G., N.K., D.F.H.), the Department of Ophthalmology (D.A.J.), the Welch Center for Prevention, Epidemiology and Clinical Research (L.J.A.), and the Institute for Clinical and Translational Research (D.E.F.), Johns Hopkins School of Medicine, and the Departments of Molecular Microbiology and Immunology (D.J.S., A.S., A.P., S.L.K., A.C.), International Health (L.L.H., C.G.S.), and Epidemiology (B.L., D.M.S., S.E., S.N.B.), Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda (O.L.), and Luminis Health, Annapolis (B.R.M.) - all in Maryland; the Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center (A.G.S.), and the Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center (S.G.K.) - both in Washington, DC; the Division of Allergy and Immunology, Department of Medicine (G.S.M.), and the Department of Pathology (T.J.G.), NorthShore University Health System, Evanston, IL; the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine (Y.F.), the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center (B.P.), Houston, and The Next Practices Group, Austin (E.C.F.) - all in Texas; the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (S.L.H.); the Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI (A.C.L.); the Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City (E.S.S.); the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (S.A.); the Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati (M.A.H.); the Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ (J.E.B.); the Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles (J.S.C.), Ascada Research (K.O., M.A.), the Department of Medicine, Division of Infectious Diseases, University of California, Irvine (D.N.F.), and the Department of Medicine, Division of Infectious Diseases, University of California, San Diego (E.R.C.) - all in California; the Department of Emergency Medicine, Wayne State University, Detroit (J.H.P.); the Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester (J.M.G.); Nuvance Health (J.R.P., W.R., M.-E.C.), and Nuvance Health Danbury Hospital (P.B.B.), Danbury, and Nuvance Health Norwalk Hospital, Norwalk (J.H., B.G.) - all in Connecticut; Nuvance Health Vassar Brothers Medical Center, Poughkeepsie (V.C.C., D.C.), the Department of Medicine, University of Rochester Medical Center, Rochester (M.S.Z.), and the Bliss Group, New York (M.R.) - all in New York; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM (J.S.R.).

Insights

Convalescent plasma therapy for COVID-19 reduced hospitalization risk by 54% in symptomatic outpatients. This treatment is effective when administered within 9 days of symptom onset, particularly for unvaccinated individuals.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Clinical Trials

Background:

  • Polyclonal convalescent plasma is derived from donors recovered from COVID-19.
  • The effectiveness of convalescent plasma in preventing severe outcomes in outpatient COVID-19 is not well-established.

Purpose of the Study:

  • To evaluate the efficacy and safety of COVID-19 convalescent plasma compared to control plasma.
  • To assess the impact of convalescent plasma on COVID-19 related hospitalizations in symptomatic adults.

Main Methods:

  • A multicenter, double-blind, randomized, controlled trial was conducted.
  • Symptomatic adults (≥18 years) testing positive for SARS-CoV-2 received either convalescent or control plasma within 9 days of symptom onset.
  • The primary outcome measured was COVID-19 related hospitalization within 28 days.

Main Results:

  • Convalescent plasma reduced hospitalization risk by 54% (2.9% vs 6.3%, P=0.005).
  • The absolute risk reduction was 3.4 percentage points (95% CI, 1.0 to 5.8).
  • Most hospitalized participants were unvaccinated; efficacy in vaccinated individuals could not be determined.

Conclusions:

  • COVID-19 convalescent plasma administration within 9 days of symptom onset reduced hospitalization risk in most unvaccinated participants.
  • The study provides evidence for the efficacy of early convalescent plasma treatment in COVID-19 outpatients.
Abstract