Convalescent Plasma Therapy for COVID-19: A Graphical Mosaic of the Worldwide Evidence

20 Pages Posted: 23 Mar 2021

See all articles by Stephen Klassen

Stephen Klassen

Mayo Clinic

Jonathon Senefeld

Mayo Clinic

Katherine Senese

Mayo Clinic

Patrick Johnson

Mayo Clinic - Florida

Chad Wiggins

Mayo Clinic

Sarah Baker

Mayo Clinic

Noud van Helmond

Rowan University

Katelyn Bruno

Mayo Clinic - Florida

Liise-anne Pirofski

Albert Einstein College of Medicine

Shmuel Shoham

Johns Hopkins University

Brenda Grossman

Washington University in St. Louis

Jeffrey Henderson

Washington University in St. Louis

Scott Wright

Mayo Clinic

DeLisa Fairweather

Mayo Clinic - Florida

Nigel Paneth

Michigan State University

Rickey Carter

Mayo Clinic - Florida

Arturo Casadevall

Johns Hopkins University - School of Hygiene and Public Health

Michael Joyner

Mayo Clinic

Date Written: March 17, 2021

Abstract

Convalescent plasma has been used worldwide to treat patients hospitalized with COVID-19 and prevent disease progression. Despite global usage uncertainty remains regarding plasma efficacy as randomized controlled trials (RCTs) have provided divergent evidence regarding the survival benefit of convalescent plasma. Here, we argue that during a global health emergency, the mosaic of evidence originating from multiple levels of the epistemic hierarchy should inform contemporary policy and healthcare decisions. Indeed, worldwide matched-control studies have generally found convalescent plasma to improve COVID-19 patient survival and RCTs have demonstrated a survival benefit when transfused early in the disease course but limited or no benefit later in the disease course when patients required greater supportive therapies. RCTs have also revealed that convalescent plasma transfusion contributes to improved symptomatology and viral clearance. To further investigate the effect of convalescent plasma on patient mortality, we performed a systematic literature review and used a meta-analytical approach to pool daily survival data from all controlled studies that reported Kaplan-Meier survival plots. Qualitative inspection of all available Kaplan-Meier survival data and an aggregate Kaplan- Meier survival plot revealed a directionally consistent pattern among studies arising from multiple levels of the epistemic hierarchy, whereby convalescent plasma transfusion was generally associated with greater patient survival. Given that convalescent plasma has a similar safety profile as standard plasma, convalescent plasma should be implemented at the immediate onset of future infectious disease outbreaks.

Note: Funding Statement: National Heart, Lung, and Blood Institute grant (5R35HL139854, to MJJ), the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK07352, to JWS and CCW), the Natural Sciences and Engineering Research Council of Canada (PDF-532926-2019, to SAK), the National Institutes of Health (1-F32-HL154320-01 to JWS), the National Institute of Allergy and Infectious Disease (R21 AI145356 and R21 AI152318, to DF; R01 AI1520789, to AC), and the National Heart, Lung, and Blood Institute (R01 HL059842, to AC).

Declaration of Interests: The authors declare no competing interests.

Keywords: convalescent plasma, COVID-19, passive-antibody therapy, SARS-CoV-2

Suggested Citation

Klassen, Stephen and Senefeld, Jonathon and Senese, Katherine and Johnson, Patrick and Wiggins, Chad and Baker, Sarah and van Helmond, Noud and Bruno, Katelyn and Pirofski, Liise-anne and Shoham, Shmuel and Grossman, Brenda and Henderson, Jeffrey and Wright, Scott and Fairweather, DeLisa and Paneth, Nigel and Carter, Rickey and Casadevall, Arturo and Joyner, Michael, Convalescent Plasma Therapy for COVID-19: A Graphical Mosaic of the Worldwide Evidence (March 17, 2021). Available at SSRN: https://ssrn.com/abstract=3806768 or http://dx.doi.org/10.2139/ssrn.3806768

Stephen Klassen (Contact Author)

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Jonathon Senefeld

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Katherine Senese

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Patrick Johnson

Mayo Clinic - Florida ( email )

4500 San Pablo Rd S
Jacksonville, FL 32224
United States

Chad Wiggins

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Sarah Baker

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Noud Van Helmond

Rowan University ( email )

201 Mullica Hill Road
Glassboro, NJ 08028
United States

Katelyn Bruno

Mayo Clinic - Florida ( email )

4500 San Pablo Rd S
Jacksonville, FL 32224
United States

Liise-anne Pirofski

Albert Einstein College of Medicine ( email )

Bronx, NY
United States

Shmuel Shoham

Johns Hopkins University ( email )

Baltimore, MD 20036-1984
United States

Brenda Grossman

Washington University in St. Louis ( email )

One Brookings Drive
Campus Box 1208
Saint Louis, MO MO 63130-4899
United States

Jeffrey Henderson

Washington University in St. Louis ( email )

One Brookings Drive
Campus Box 1208
Saint Louis, MO MO 63130-4899
United States

Scott Wright

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

DeLisa Fairweather

Mayo Clinic - Florida ( email )

4500 San Pablo Rd S
Jacksonville, FL 32224
United States

Nigel Paneth

Michigan State University ( email )

Agriculture Hall
East Lansing, MI 48824-1122
United States

Rickey Carter

Mayo Clinic - Florida ( email )

4500 San Pablo Rd S
Jacksonville, FL 32224
United States

Arturo Casadevall

Johns Hopkins University - School of Hygiene and Public Health ( email )

Baltimore, MD 21205
United States

Michael Joyner

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

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