Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks

Wooding, Denise J.; Bach, Horacio

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.