Immunocompromised COVID-19 Patients May Benefit From Convalescent Plasma Treatment

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, stated a press release issued by the University of Pittsburgh School of Medicine (UPMC) on October 4, 2021.

The hypothesis was that components in the so-called “convalescent plasma” that fought off the disease once could do it again, which has worked in other diseases, such as Ebola.

However, an international research team, which included the UPMC physician-scientists and patients, effectively ended that practice.

A phase 4 clinical trial has concluded convalescent plasma is “futile” as a COVID-19 treatment for most critically ill patients.

But the researchers could not determine why convalescent plasma did not improve outcomes in most critically ill patients.

“There were biologically plausible reasons to turn to convalescent plasma early in the COVID-19 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 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.”

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 than the standard treatment, but the number of patients was too small to make a definitive statement.

The immunoglobulin domain randomized participants received two units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization.

“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., an associate professor of hematology 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 results are published in JAMA concurrent with a presentation at the European Society of Intensive Care Medicine’s annual meeting.