Treatment of Coronavirus Disease 2019 (COVID-19) Patients with Convalescent Plasma

Eric Salazar, Katherine K Perez, Madiha Ashraf, Jian Chen, Brian Castillo, Paul A Christensen, Taryn Eubank, David W Bernard, Todd N Eagar, S Wesley Long, Sishir Subedi, Randall J Olsen, Christopher Leveque, Mary R Schwartz, Monisha Dey, Cheryl Chavez-East, John Rogers, Ahmed Shehabeldin, David Joseph, Guy Williams, Karen Thomas, Faisal Masud, Christina Talley, Katharine G Dlouhy, Bevin V Lopez, Curt Hampton, Jason Lavinder, Jimmy D Gollihar, Andre C Maranhao, Gregory C Ippolito, Matthew O Saavedra, Concepcion C Cantu, Prasanti Yerramilli, Layne Pruitt, James M Musser, Eric Salazar, Katherine K Perez, Madiha Ashraf, Jian Chen, Brian Castillo, Paul A Christensen, Taryn Eubank, David W Bernard, Todd N Eagar, S Wesley Long, Sishir Subedi, Randall J Olsen, Christopher Leveque, Mary R Schwartz, Monisha Dey, Cheryl Chavez-East, John Rogers, Ahmed Shehabeldin, David Joseph, Guy Williams, Karen Thomas, Faisal Masud, Christina Talley, Katharine G Dlouhy, Bevin V Lopez, Curt Hampton, Jason Lavinder, Jimmy D Gollihar, Andre C Maranhao, Gregory C Ippolito, Matthew O Saavedra, Concepcion C Cantu, Prasanti Yerramilli, Layne Pruitt, James M Musser

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread globally, and no proven treatments are available. Convalescent plasma therapy has been used with varying degrees of success to treat severe microbial infections for >100 years. Patients (n = 25) with severe and/or life-threatening COVID-19 disease were enrolled at the Houston Methodist hospitals from March 28, 2020, to April 14, 2020. Patients were transfused with convalescent plasma, obtained from donors with confirmed severe acute respiratory syndrome coronavirus 2 infection who had recovered. The primary study outcome was safety, and the secondary outcome was clinical status at day 14 after transfusion. Clinical improvement was assessed on the basis of a modified World Health Organization six-point ordinal scale and laboratory parameters. Viral genome sequencing was performed on donor and recipient strains. At day 7 after transfusion with convalescent plasma, nine patients had at least a one-point improvement in clinical scale, and seven of those were discharged. By day 14 after transfusion, 19 (76%) patients had at least a one-point improvement in clinical status, and 11 were discharged. No adverse events as a result of plasma transfusion were observed. Whole genome sequencing data did not identify a strain genotype-disease severity correlation. The data indicate that administration of convalescent plasma is a safe treatment option for those with severe COVID-19 disease.

Copyright © 2020 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Respiratory support status, clinical score, patient outcomes (discharge/death), and receptor binding domain (RBD) titer of transfused plasma in a 25-patient cohort. Respiratory support requirements for the duration of hospitalization are color coded per the key. Discharge or death is indicated by open or closed squares, respectively. Patients without a square symbol were still hospitalized at day 14 after transfusion (study end point). Patient 16 was given a second transfusion on day 6, indicated by a vertical line. The convalescent plasma titers for the RBD domain of the severe acute respiratory syndrome coronavirus 2 spike protein are indicated to the left. ECMO, extracorporeal membrane oxygen; ELISA, enzyme-linked immunosorbent assay; NA, not available; NC, nasal cannula; NIPPV, noninvasive, positive-pressure ventilation.
Figure 2
Figure 2
Clinical outcomes at days 7 and 14 after transfusion. Distribution of patients on low-flow, high-flow, invasive, or no oxygen support at days 0 (day of transfusion), 7, and 14. By day 7 after transfusion, 36% (9/25) of patients had improved from baseline; 76% (19/25) of patients improved by day 14 after transfusion. Inv., Invasive.

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