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COVID-19 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization

Authors :
Levine, Adam C
Fukuta, Yuriko
Huaman, Moises A
Ou, Jiangda
Meisenberg, Barry R
Patel, Bela
Paxton, James H
Hanley, Daniel F
Rijnders, Bart Ja
Gharbharan, Arvind
Rokx, Casper
Zwaginga, Jaap Jan
Alemany, Andrea
Mitjà, Oriol
Ouchi, Dan
Millat-Martinez, Pere
Durkalski-Mauldin, Valerie
Korley, Frederick K
Dumont, Larry J
Callaway, Clifton W
Libster, Romina
Marc, Gonzalo Perez
Wappner, Diego
Esteban, Ignacio
Polack, Fernando
Sullivan, David J
Internal Medicine
Surgery
Medical Microbiology & Infectious Diseases
Source :
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Oxford University Press
Publication Year :
2023
Publisher :
Oxford University Press, 2023.

Abstract

Background Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results. Methods We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022. Results Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. Conclusions Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.

Details

Language :
English
ISSN :
15376591 and 10584838
Volume :
76
Issue :
12
Database :
OpenAIRE
Journal :
Clinical Infectious Diseases
Accession number :
edsair.doi.dedup.....4d20eebb71257443f904783be2111dcb