Covalescent plasma has been vindicated and proven.
Growing evidence shows benefits in the immunocompromised
www.medpagetoday.com
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COVID Convalescent Plasma Finds a Therapeutic Role
— Growing evidence shows benefits in the immunocompromised
by Arturo Casadevall, MD, PhD, Jeffrey P. Henderson MD, PhD, Brenda J. Grossman, MD, MPH, Michael J. Joyner, MD, Shmuel Shoham, MD, Nigel Paneth, MD, MPH, and Liise-anne Pirofski, MD June 19, 2022
In the dark days of the early COVID-19 pandemic, when there was no known therapy,
COVID-19 convalescent plasma (CCP) brought a ray of hope. COVID-19 survivors, community organizers, clinicians, regulators, and blood bankers collaborated to quickly bring CCP to patients. First used at the end of March 2020 in the U.S.,
40% of all hospitalized patients were being treated with CCP by October 2020, considerable progress for a treatment without pharmaceutical industry support.
Since those early days, CCP use has largely fallen off based on insufficient evidence of efficacy in hospitalized patients and the availability of other therapies. But growing evidence has shown benefits of CCP in a population with diminished treatment options and vaccine responses: the immunocompromised. This population encompasses about
3% of the population and their needs have been relatively neglected in treatment guidelines during the COVID-19 pandemic.
A Review of CCP History and Data
Guided by
historical principles of antibody therapy dictating early use that were increasingly affirmed by contemporary data, more clinicians began to treat COVID-19 patients with CCP as
rapidly as possible after hospital admission during the beginning of the pandemic. The FDA issued an
Emergency Use Authorization (EUA) for inpatient CCP use in August 2020. However, several randomized controlled trials (RCTs) then reported no benefit of CCP in hospitalized COVID-19 patients. These trials, conducted mostly abroad, tested CCP in critically ill patients, some using CCP units
without sufficient antibody content. Negative results from these trials were generalized to all COVID-19 patients, irrespective of their stage of disease, contributing to a precipitous decline in CCP use by early 2021. The concurrent approval and increased availability of remdesivir, which is also most effective in the early stage of COVID-19 infection, may also have contributed to diminished CCP demand.
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