Convalescent plasma futile as treatment for critically ill COVID-19
patients, study finds

Date:
October 4, 2021
Source:
University of Pittsburgh
Summary:
An international research team effectively put an end to that
practice with a clinical trial that concluded convalescent plasma is
'futile' as a COVID-19 treatment for most critically ill patients.



FULL STORY ==========================================================================
In the earliest days of the COVID-19 pandemic, the medical community
turned to a century-old treatment: Take blood from recovered patients and
give it to the sick. The hypothesis was that components in the so-called "convalescent plasma" that fought off the disease once could do it again, something that has worked in other diseases, such as Ebola.


========================================================================== Today, an international research team, which included University of
Pittsburgh School of Medicine physician-scientists and UPMC patients, effectively put an end to that practice with a clinical trial that
concluded convalescent plasma is "futile" as a COVID-19 treatment for most critically ill patients. The results are published in JAMA concurrent
with presentation at the European Society of Intensive Care Medicine's
annual meeting.

"There were biologically plausible reasons to turn to convalescent plasma
early in the pandemic when hundreds of thousands of people were getting
sick and treatments had yet to be discovered," said co-lead author
Bryan McVerry, M.D., associate professor of pulmonary, allergy and
critical care medicine at Pitt and a UPMC intensivist. "Unfortunately,
it was either being administered outside of clinical trials or in trials
that weren't focused on critically ill patients, slowing our ability
to see if it actually worked. Finally, with these results, we can put
an end to using convalescent plasma for our sickest COVID- 19 patients
and focus on treatments that we know work, as well as developing and
testing better ones." The findings are the latest from REMAP-CAP
(Randomised, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia), which has enrolled thousands of patients
in hundreds of hospitals around the world to quickly determine what
COVID-19 treatments work best in which patients. To date, more than 400
UPMC patients have been enrolled. Among its discoveries, REMAP-CAP has
shown that inexpensive steroids are effective in helping critically ill patients, while blood thinners help the moderately ill.

In the convalescent plasma trial, REMAP-CAP enrolled 2,011 adults
hospitalized with severe COVID-19. They were randomized to either
receive two units of convalescent plasma or no plasma and followed to
see if the likelihood of surviving at least three weeks without needing
organ support, such as a ventilator, differed based on whether they were treated or not.

The trial concluded for futility when enough data was collected to say
with greater than 99% certainty that convalescent plasma did not help critically ill COVID-19 patients.

However, the results followed a slightly different pattern for the 126
patients who were immunocompromised. This group appeared to do slightly
better with the convalescent plasma treatment compared to the standard treatment, but the number of patients was too small to make a definitive statement.

"It could be that patients with an impaired immune system, who are
unable to mount an effective immune response, could still benefit from
the antibodies present in blood plasma from COVID-recovered patients, especially early on in the illness," said corresponding author Lise
Estcourt, M.D., a associate professor of haematology and transfusion
medicine at the Oxford University's Radcliffe Department of Medicine
and director of the U.K.'s National Health Service Blood and Transplant Clinical Trials Unit. "This is something that definitely warrants investigation." The researchers could not determine why convalescent
plasma did not improve outcomes in most critically ill patients.

"We speculate that it could be a combination of too few high-quality
antibodies in the plasma and these patients being too far along in their illness with a run-away inflammatory immune response for those antibodies
to turn the tide," said co-senior author Derek Angus, M.D., M.P.H., chief innovation officer at UPMC and chair of the Department of Critical Care Medicine at Pitt. "It is still possible that convalescent plasma helps
people in earlier stages of illness, though it is likely not efficient to
use given that monoclonal antibodies -- which UPMC also is evaluating in
our OPTIMISE-C19 adaptive trial -- are such an effective treatment for
early COVID-19." Additional co-authors of this research from Pitt or
UPMC are David T. Huang, M.D., M.P.H., Kelsey Linstrum, M.S., Stephanie Montgomery, M.Sc., Christopher Seymour, M.D., M.Sc., John McDyer, M.D.,
and Darrell Triulzi, M.D. Authors at other institutions are listed in
the JAMA manuscript.

This research was supported by the UPMC Learning While Doing Program,
as well as multiple other funders listed in the JAMA manuscript.

========================================================================== Story Source: Materials provided by University_of_Pittsburgh. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Writing Committee for the REMAP-CAP Investigators. Effect of
Convalescent
Plasma on Organ Support-Free Days in Critically Ill Patients With
COVID- 19A Randomized Clinical Trial. JAMA, Oct. 4, 2021 DOI:
10.1001/ jama.2021.18178 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/10/211004140313.htm

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