Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis
Open Access
- 7 April 2021
- journal article
- review article
- Published by JMIR Publications Inc. in JMIR Public Health and Surveillance
- Vol. 7 (4), e25500
- https://doi.org/10.2196/25500
Abstract
Background: The COVID-19 pandemic, caused by a novel coronavirus termed SARS-CoV-2, has spread quickly worldwide. Convalescent plasma (CP) obtained from patients following recovery from COVID-19 infection and development of antibodies against the virus is an attractive option for either prophylactic or therapeutic treatment, since antibodies may have direct or indirect antiviral activities and immunotherapy has proven effective in principle and in many clinical reports. Objective: We seek to characterize the latest advances and evidence in the use of CP for COVID-19 through a systematic review and quantitative analysis, identify knowledge gaps in this setting, and offer recommendations and directives for future research. Methods: PubMed, Web of Science, and Embase were continuously searched for studies assessing the use of CP for COVID-19, including clinical studies, commentaries, reviews, guidelines or protocols, and in vitro testing of CP antibodies. The screening process and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal of all clinical studies was conducted using a universal tool independent of study designs. A meta-analysis of case-control and randomized controlled trials (RCTs) was conducted using a random-effects model. Results: Substantial literature has been published covering various aspects of CP therapy for COVID-19. Of the references included in this review, a total of 243 eligible studies including 64 clinical studies, 79 commentary articles, 46 reviews, 19 guidance and protocols, and 35 in vitro testing of CP antibodies matched the criteria. Positive results have been mostly observed so far when using CP for the treatment of COVID-19. There were remarkable heterogeneities in the CP therapy with respect to patient demographics, donor antibody titers, and time and dose of CP administration. The studies assessing the safety of CP treatment reported low incidence of adverse events. Most clinical studies, in particular case reports and case series, had poor quality. Only 1 RCT was of high quality. Randomized and nonrandomized data were found in 2 and 11 studies, respectively, and were included for meta-analysis, suggesting that CP could reduce mortality and increase viral clearance. Despite promising pilot studies, the benefits of CP treatment can only be clearly established through carefully designed RCTs. Conclusions: There is developing support for CP therapy, particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. These studies provide important lessons that should inform the planning of well-designed RCTs to generate more robust knowledge for the efficacy of CP in patients with COVID-19. Future research is necessary to fill the knowledge gap regarding prevention and treatment for patients with COVID-19 with CP while other therapeutics are being developed.This publication has 324 references indexed in Scilit:
- Use of quality assessment tools in systematic reviews was varied and inconsistentJournal of Clinical Epidemiology, 2016
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile rangeBMC Medical Research Methodology, 2014
- The Effectiveness of Convalescent Plasma and Hyperimmune Immunoglobulin for the Treatment of Severe Acute Respiratory Infections of Viral Etiology: A Systematic Review and Exploratory Meta-analysisThe Journal of Infectious Diseases, 2014
- Incidence of Transfusion-Related Adverse Reactions per Patient Reflects the Potential Risk of Transfusion Therapy in JapanAmerican Journal of Clinical Pathology, 2013
- Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological researchJournal of Evaluation in Clinical Practice, 2012
- Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza A (H1N1) 2009 Virus InfectionClinical Infectious Diseases, 2011
- A typology of reviews: an analysis of 14 review types and associated methodologiesHealth Information and Libraries Journal, 2009
- A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing InterventionsWorldviews on Evidence-Based Nursing, 2004
- Passive Immunity in Prevention and Treatment of Infectious DiseasesClinical Microbiology Reviews, 2000