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Efficacy and Safety of Convalescence Plasma Therapy in COVID-19 Patients: A Systematic Review and Meta-Analysis
Rongjuan Dai1, Minjie Hu2, Haibo Tang1
1The First Affiliated Hospital, Department of Infectious Diseases, Hengyang Medical School, University of South China, Hengyang 421001, Hunan, China.
Insights
Convalescent plasma (CP) therapy for COVID-19 significantly reduced mortality and improved respiratory symptoms. While effective in lowering inflammatory markers like IL-6 and ferritin, CP did not impact viral clearance or adverse reactions, warranting further research.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- The COVID-19 pandemic presents a high mortality rate, with ongoing research into effective treatments.
- Convalescent plasma (CP) therapy has emerged as a potential intervention, though its efficacy remains debated.
- Understanding the impact of CP on COVID-19 outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To conduct a meta-analysis assessing the efficacy and safety of convalescent plasma (CP) therapy for COVID-19 patients.
- To evaluate the impact of CP on mortality, clinical symptoms, inflammatory markers, and virological indicators.
Main Methods:
- A comprehensive literature search was performed across multiple databases up to August 30, 2021.
- Included thirteen randomized controlled trials (RCTs) involving 13,232 participants.
- Pooled data using fixed or random effect models for dichotomous and continuous outcomes, calculating Risk Ratios (RR) and Mean Differences (MD) with 95% confidence intervals (CIs).
Main Results:
- Convalescent plasma therapy was associated with a statistically significant reduction in mortality (RR: 0.70, 95% CI: 0.55-0.89).
- Significant improvements were observed in shortness of breath, and reductions in Interleukin-6 (IL-6) and Ferritin levels.
- No significant differences were found in ventilator use, imaging results, hospital discharge time, viral clearance, or adverse reaction rates.
Conclusions:
- Convalescent plasma therapy shows promise for COVID-19, demonstrating safety and efficacy in reducing mortality and improving key symptoms and inflammatory markers.
- CP therapy effectively lowers IL-6 and ferritin levels without a significant increase in adverse events.
- Further high-quality clinical trials are recommended to validate these findings and establish definitive treatment guidelines.
Background:
The coronavirus disease 2019 (COVID-19) has outbroken into a global pandemic. The death rate for hospital patients varied between 11% and 15%. Although COVID-19 is extremely contagious and has a high fatality rate, the amount of knowledge available in the published literature and public sources is rapidly growing. The efficacy of convalescent plasma (CP) therapy for COVID-19 is controversial.
Objective:
This meta-analysis was designed to assess the efficacy of CP therapy for COVID-19 through a literature survey.
Methods:
Until August 30, 2021, a literature search was undertaken in Pubmed, Embase, Web of Science, Cochrane Central Register of Controlling Trials (Central), and China National Knowledge Infrastructure databases. The Risk Ratio (RR) and 95% confidence intervals (CIs) were pooled using a fixed or random effect model in dichotomous data. Mean difference (MD) and 95% confidence intervals (CIs) were pooled using a fixed or random effect model in continuous data. Studies with missing or unsuitable data were presented descriptively in the outcomes.
Results:
In total, thirteen randomized controlled trials (RCTs) were selected for the present meta-analysis, which included a total of 13232 participants. Our results revealed that the CP group has lower mortality compared to the control group, and there was a statistically significant difference (RR: 0.70, 95% CI: 0.55, 0.89, Z = 2.92, P = 0.004 < 0.01); other secondary outcomes such as the shortness of breath symptom improved significantly in CP group (RR:1.48, 95% CI: 1.13, 1.93, Z = 2.85, P = 0.004 < 0.01), as well as Interleukin-6 (IL-6) (MD: -4.46, 95% CI: -8.28, -0.63, Z = 2.28, P = 0.02 < 0.05) and Ferritin (MD: -447.68, 95% CI: -501.75, -393.6, Z = 16.23, P < 0.00001) are reduced significantly in CP group. However, there was no statistically significant change in the ventilator withdrawal rate, imaging results improvement, or days to hospital discharge. There was also no substantial difference in viral nucleic acid negative conversion rate and neutralizing antibody-positive conversion rate, as well as the incidence of adverse reactions.
Conclusions:
The safety and potential efficacy of convalescent plasma therapy offer a promising treatment strategy for COVID-19. CP therapy can reduce mortality and improve breath and inflammatory cytokines IL-6 and Ferritin in COVID-19 with no significant increase in adverse reactions. However, it does not affect improving virology indicators. In summary, more high-quality clinical trials are needed to verify the conclusion of the present study.
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