Therapies to interrupt the progression of early coronavirus disease 2019 (Covid-19) remain elusive. Among them, convalescent plasma administered to hospitalized patients has been unsuccessful, perhaps because antibodies should be administered earlier in the course of illness.
We conducted a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adult patients within 72 hours after the onset of mild Covid-19 symptoms. The primary end point was severe respiratory disease, defined as a respiratory rate of 30 breaths per minute or more, an oxygen saturation of less than 93% while the patient was breathing ambient air, or both. The trial was stopped early at 76% of its projected sample size because cases of Covid-19 in the trial region decreased considerably and steady enrollment of trial patients became virtually impossible.
A total of 160 patients underwent randomization. In the intention-to-treat population, severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; P=0.03), with a relative risk reduction of 48%. A modified intention-to-treat analysis that excluded 6 patients who had a primary end-point event before infusion of convalescent plasma or placebo showed a larger effect size (relative risk, 0.40; 95% CI, 0.20 to 0.81). No solicited adverse events were observed.
Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19. (Funded by the Bill and Melinda Gates Foundation and the Fundación INFANT Pandemic Fund; Dirección de Sangre y Medicina Transfusional del Ministerio de Salud number, PAEPCC19, Plataforma de Registro Informatizado de Investigaciones en Salud number, 1421, and ClinicalTrials.gov number,
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (Covid-19), causes a particularly severe illness in older adults. The percentage of these patients who are hospitalized is high, and most deaths from Covid-19 worldwide occur in this age group.1,2 Various coexisting conditions adversely affect the prognosis in patients with Covid-19, regardless of age. These conditions include hypertension, diabetes, cardiovascular disease, obesity, chronic renal failure, and chronic obstructive pulmonary disease (COPD).1,2
Treatments for Covid-19 in the early stages of the disease remain elusive. Few strategies provide benefit, several have failed, and others are being evaluated.3-12 Among the strategies under investigation is the infusion of specific antibodies that are present in the plasma of convalescent patients.7-12 Plasma infusions have not been commonly associated with adverse events13 and have been associated with improved outcomes in patients who have had other diseases.14-16 However, antibodies in plasma must be administered soon after infection in order to be effective.14-16
In hospitalized patients with Covid-19, the infusion of convalescent plasma against SARS-CoV-2 late in the course of illness has not shown clear benefits and, consequently, the most appropriate antibody concentrations for effective treatment are unclear.7-12 We evaluated whether convalescent plasma with high SARS-CoV-2 antibody titers, administered within 72 hours after the onset of mild symptoms, would be efficacious in preventing progression to severe disease in older adult patients with Covid-19.
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