Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults

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.

Libster, Romina, Gonzalo Pérez Marc, Diego Wappner, Silvina Coviello, Alejandra Bianchi, Virginia Braem, Ignacio Esteban, Mauricio T. Caballero, Cristian Wood, Mabel Berrueta, Aníbal Rondan, Gabriela Lescano, Pablo Cruz, Yvonne Ritou, Valeria Fernández Viña, Damián Álvarez Paggi, Sebastián Esperante, Adrián Ferreti, Gastón Ofman, Álvaro Ciganda, Rocío Rodriguez, Jorge Lantos, Ricardo Valentini, Nicolás Itcovici, Alejandra Hintze, M. Laura Oyarvide, Candela Etchegaray, Alejandra Neira, Ivonne Name, Julieta Alfonso, Rocío López Castelo, Gisela Caruso, Sofía Rapelius, Fernando Alvez, Federico Etchenique, Federico Dimase, Darío Alvarez, Sofía S. Aranda, Clara Sánchez Yanotti, Julián De Luca, Sofía Jares Baglivo, Sofía Laudanno, Florencia Nowogrodzki, Ramiro Larrea, María Silveyra, Gabriel Leberzstein, Alejandra Debonis, Juan Molinos, Miguel González, Eduardo Perez, Nicolás Kreplak, Susana Pastor Argüello, Luz Gibbons, Fernando Althabe, Eduardo Bergel, and Fernando P. Polack.

2021-02-18

Libster, Romina, Gonzalo Pérez Marc, Diego Wappner, Silvina Coviello, Alejandra Bianchi, Virginia Braem, Ignacio Esteban, Mauricio T. Caballero, Cristian Wood, Mabel Berrueta, Aníbal Rondan, Gabriela Lescano, Pablo Cruz, Yvonne Ritou, Valeria Fernández Viña, Damián Álvarez Paggi, Sebastián Esperante, Adrián Ferreti, Gastón Ofman, Álvaro Ciganda, Rocío Rodriguez, Jorge Lantos, Ricardo Valentini, Nicolás Itcovici, Alejandra Hintze, M. Laura Oyarvide, Candela Etchegaray, Alejandra Neira, Ivonne Name, Julieta Alfonso, Rocío López Castelo, Gisela Caruso, Sofía Rapelius, Fernando Alvez, Federico Etchenique, Federico Dimase, Darío Alvarez, Sofía S. Aranda, Clara Sánchez Yanotti, Julián De Luca, Sofía Jares Baglivo, Sofía Laudanno, Florencia Nowogrodzki, Ramiro Larrea, María Silveyra, Gabriel Leberzstein, Alejandra Debonis, Juan Molinos, Miguel González, Eduardo Perez, Nicolás Kreplak, Susana Pastor Argüello, Luz Gibbons, Fernando Althabe, Eduardo Bergel, and Fernando P. Polack. 2021. "Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults." New England Journal of Medicine 384 (7):610-8.

Background

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.

Methods

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.

Results

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.

Conclusions

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, NCT04479163. opens in new tab.)

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