Convalescent plasma may be of clinical benefit for treatment of 2019 Novel Coronavirus. We conducted a systematic review and meta-analysis of these interventions, including Middle East respiratory syndrome-Coronavirus (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV) to summarize reliable evidences of the treatment.Methods:Three major electronic databases (PubMed, Google scholar) were searched，Several studies were collected for Meta-analysis.Results:Seven studies were included in Meta-analysis, including a total number of 416 patients with SARS and 169 patients with MERS infection. Meta-analysis shows that in critically ill patients, the Convalescent plasma can reduced mortality significently. (odds ratio [OR]=0.27;95% confidence interval [CI]=0.15-0.50; I2=0%;P = 0.47).Conclusions:The therapy of Convalescent plasma can reduce mortality of patients with Coronavirus，and it need to be further verified with Large-scale clinical trial.
Introduction: In addition to antiviral medication, Convalescent plasma therapy (CPT) has also been investigated for COVID-19 treatment. This study aimed to evaluate CPT potentials in COVID-19 treatment, by performing systematic review and meta-analysis of studies in COVID-19 and other similar viral respiratory diseases, including Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and Influenza. Method: PubMed and Google scholars database were used to collect publications up to June 6, 2020. We included all studies reported clinical outcomes of severe to critically ill viral respiratory diseases patients. Review/systematic review/meta-analysis and articles not written in English, ineligible for full-access were excluded. Meta-analysis used Mantel-Haezel Risk Ratio (RR) with 95% confidence interval for dichotomous data, while mean difference was calculated for continuous data with random effect model. Pooled analysis for individual patients data were performed with Inverse Variance Weighted Average using random effect model. The study is registered with PROSPERO, number CRD42020190579. Result: Our search identified 3,786 studies. Nineteen studies with 436 participants were included in the meta-analysis. Pooled analysis showed reduction of mortality [RR 0.46 (0.24, 0.86), z=2.41(p=0.02), I 2 =68% (p=0.003)] and higher number of discharged patients [RR 1.28 (1.12, 1.46), z=3.61 (p=0.0003), I 2 =73% (p=0.002)] in CPT groups. The mean time to discharge in COVID-19 patients after receiving CPT is 18.35 days. Possible CPT mechanism of action is due to its ability to immediately reduce viral titer [Mean diff -0.68(-0.94, -0.41), z=5.03 (p<0.00001), I 2 =0% (p=0.87)]. Adverse effect during transfusion was reported in 2 (2.2%) COVID-19 patients, and TRALI was identified in 2 (1.9%) SARS and MERS patients. Interpretation: CPT offers an easier and safer application during this pandemic, particularly when specific vaccines and medications are not yet available. Further investigation involving more patients and in combination with other treatment modalities are urgently needed. Funding: None Declaration of Interests: All authors have nothing to declare.
OBJECTIVE: To systematically review evidence for the effect of convalescent plasma and immunoglobulin on treatment of severe acute respiratory syndrome (SARS), and further provide advice on the treatment of coronavirus disease 2019 (COVID-19).
METHODS: Clinical studies of convalescent plasma and immunoglobulin in the treatment of SARS were collected from a variety of databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang, and CBM from November 2002 to March 2020. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias based on the national institute for health and clinical excellence case series quality scale, and systematically evaluated the results.
RESULTS: A total of 10 clinical studies, including 212 patients, were eventually included. There were 4 case series studies, 5 case reports and 1 case-control study. Most studies were with low or very low quality. The systematic analysis showed that 107 patients administered convalescent plasma and 16 patients used immunoglobulin during the treatment of SARS. Forty-nine patients were definitely not treated with the above two methods, and the remaining 40 patients were not reported clearly. The treatment of convalescent plasma and immunoglobulin could both improve the symptoms and reduce the mortality (12 died), and most SARS patients got better, while 11 SARS patients who did not receive the above therapies died.
CONCLUSIONS: Convalescent plasma and immunoglobulin were effective on relieving symptoms of SARS patients. However, due to low quality and lacking of control group, convalescent plasma and immunoglobulin should be used with caution to treat COVID-19 patients.
BACKGROUND: There is currently no treatment known to alter the course of COVID-19. Convalescent plasma has been used to treat a number of infections during pandemics, including SARS-CoV, MERS-CoV, and now COVID-19.
OBJECTIVES: To summarize the existing literature and registered clinical trials on the efficacy and safety of convalescent plasma for treating coronaviruses, and discuss issues of feasibility, and donor and patient selection.
SOURCES: A review of articles published in PubMed was performed on July 13, 2020, to summarize the currently available evidence in human studies for convalescent plasma as a treatment for coronaviruses. The World Health Organization International Clinical Trials Registry and clinicaltrials.gov were searched to summarize the currently registered randomized clinical trials for convalescent plasma in COVID-19.
CONTENT: There were sixteen COVID-19, four MERS-CoV, and five SARS-CoV reports describing convalescent plasma use in humans. There were two randomized control trials, both of which were for COVID-19 and were terminated early. Most COVID-19 reports described a potential benefit of convalescent plasma on clinical outcomes in severe or critically ill patients with few immediate adverse events. However, there were a number of limitations, including the concurrent use of antivirals, steroids, and other treatments, small sample sizes, lack of randomization or control groups, and short follow-up time. Data from SARS-CoV and COVID-19 suggest that earlier administration likely yields better outcomes. The ideal candidates for recipients and donors are not known. Still, experience with prior coronaviruses tells us that antibodies in convalescent patients are probably short-lived. Patients who had more severe disease and who are earlier in their course of recovery may be more likely to have adequate titres. Finally, a number of practical challenges were identified.
IMPLICATIONS: There is currently no effective treatment for COVID-19, and preliminary trials for convalescent plasma suggest there may be some benefits. However, research to date is at high risk of bias, and randomized control trials are desperately needed to determine the efficacy and safety of this therapeutic option.
Report»Hospital Alemão Oswaldo Cruz. Unidade de Avaliação de Tecnologias em Saúde; Hospital Sírio-Libanês. Núcleo de Avaliação de Tecnologias em Saúde; Hospital Moinhos de Vento. Núcleo de Avaliações de Tecnologias em Saúde.
BACKGROUND: Convalescent plasma (CP) has been used successfully to treat many types of infectious diseases, and it has shown initial effects in the treatment of the emerging 2019 coronavirus disease (COVID-19). However, its curative effect and feasibility have yet to be confirmed by formal evaluation and well-designed clinical trials. To explore the effectiveness of treatment and predict the potential effect of CP for COVID-19, studies of different types of infectious diseases treated with CP were included in this systematic review and meta-analysis.
METHODS: Related studies were obtained from databases and screened based on the inclusion criteria. The data quality was assessed, and the data were extracted and pooled for analysis.
RESULTS: We included 40 studies on CP treatment for infectious diseases We found that CP treatment could reduce the risk of mortality with a low incidence of adverse events, promote the production of antibodies, show the decline in viral load, and shorten the disease course. A meta-analysis of 15 controlled studies showed that there was a significantly lower mortality rate in the group treated with CP (pooled OR = 0.32, 95% CI: 0.19-0.52, P < 0.001, I2 = 54%) than in the control groups. Studies were mostly of low or very low quality with a moderate or high risk of bias. The sources of clinical and methodological heterogeneity were identified. The exclusion of heterogeneity indicated that the results were stable.
CONCLUSIONS: CP therapy has some curative effect and is well tolerated to treat infectious diseases. It is a potentially effective treatment for COVID-19.
BACKGROUND: Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence.
METHODS: Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken.
RESULTS: We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14-.45; I(2) = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified.
CONCLUSIONS: Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection.
The Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been detected in a number of countries in the Middle East and Europe with an apparently high mortality rate. It is phylogenetically related to the SARS coronavirus and has also been associated with severe respiratory illness as well as nosocomial transmission in healthcare settings. Current international recommendations do not support any specific therapies; however, there are a number of agents, which were used during the SARS epidemic of 2003. It is possible that these might be active against the related MERS coronavirus. We have reviewed the literature on the safety and efficacy of therapies used in patients with SARS with a view to their potential use in patients with MERS-CoV infections.
