Treatment of Severe COVID-19 with Convalescent Plasma in the Bronx, NYC

Hyun Ah Yoon, Rachel Bartash, Inessa Gendlina, Johanna Rivera, Antonio Nakouzi, Robert H Bortz 3rd, Ariel S Wirchnianski, Monika Paroder, Karen Fehn, Leana Serrano-Rahman, Rachelle Babb, Uzma N Sarwar, Denise Haslwanter, Ethan Laudermilch, Catalina Florez, M Eugenia Dieterle, Rohit K Jangra, J Maximilian Fels, Karen Tong, Margarette C Mariano, Olivia Vergnolle, George I Georgiev, Natalia G Herrera, Ryan J Malonis, Jose A Quiroz, Nicholas C Morano, Gregory J Krause, Joseph M Sweeney, Kelsie Cowman, Stephanie Allen, Jayabhargav Annam, Ariella Applebaum, Daniel Barboto, Ahmed Khokhar, Brianna J Lally, Audrey Lee, Max Lee, Avinash Malaviya, Reise Sample, Xiuyi A Yang, Yang Li, Rafael Ruiz, Raja Thota, Jason Barnhill, Doctor Y Goldstein, Joan Uehlinger, Scott J Garforth, Steven C Almo, Jonathan R Lai, Morayma Reyes Gil, Amy S Fox, Kartik Chandran, Tao Wang, Johanna P Daily, Liise-Anne Pirofski, Hyun Ah Yoon, Rachel Bartash, Inessa Gendlina, Johanna Rivera, Antonio Nakouzi, Robert H Bortz 3rd, Ariel S Wirchnianski, Monika Paroder, Karen Fehn, Leana Serrano-Rahman, Rachelle Babb, Uzma N Sarwar, Denise Haslwanter, Ethan Laudermilch, Catalina Florez, M Eugenia Dieterle, Rohit K Jangra, J Maximilian Fels, Karen Tong, Margarette C Mariano, Olivia Vergnolle, George I Georgiev, Natalia G Herrera, Ryan J Malonis, Jose A Quiroz, Nicholas C Morano, Gregory J Krause, Joseph M Sweeney, Kelsie Cowman, Stephanie Allen, Jayabhargav Annam, Ariella Applebaum, Daniel Barboto, Ahmed Khokhar, Brianna J Lally, Audrey Lee, Max Lee, Avinash Malaviya, Reise Sample, Xiuyi A Yang, Yang Li, Rafael Ruiz, Raja Thota, Jason Barnhill, Doctor Y Goldstein, Joan Uehlinger, Scott J Garforth, Steven C Almo, Jonathan R Lai, Morayma Reyes Gil, Amy S Fox, Kartik Chandran, Tao Wang, Johanna P Daily, Liise-Anne Pirofski

Abstract

Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as treatment for Coronavirus Disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200mL of CCP with a Spike protein IgG titer ≥1:2,430 (median 1:47,385) within 72 hours of admission to propensity score-matched controls cared for at a medical center in the Bronx, between April 13 to May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroids, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared to matched controls, CCP recipients <65 years had 4-fold lower mortality and 4-fold lower deterioration in oxygenation or mortality at day 28. For CCP recipients, pre-transfusion Spike protein IgG, IgM and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients <65 years, but data from controlled trials is needed to validate this finding and establish the effect of ageing on CCP efficacy.

Conflict of interest statement

Conflicts of Interest statement

KC is a member of the Scientific Advisory Board of Integrum Scientific, LLC. In addition, KC has a SARS-CoV-2 spike neutralization assay patent pending, and a SARS-CoV-2 spike antibody assay patent pending. JL reports grants from Adimab LLC, grants from Integrated BioTherapeutics, grants from Mapp Biopharmaceutical, personal fees from Johnson & Johnson, personal fees from Celdara Medical. In addition, JL has a COVID-19 antibody diagnostic patent pending. Other authors have declared that no conflict of interest exists.

Figures

Figure 1.
Figure 1.
Enrollment of Study Patients and Distribution of Study Cohorts. Study baseline was defined as time of CCP transfusion for CCP recipients and admission day 2 for non CCP recipients. COVID-19, coronavirus disease 2019; CCP, COVID-19 convalescent plasma; EAP, expanded access protocol; LAR, legally authorized representative; MMC, Montefiore Medical Center; NC, nasal cannula.
Figure 2.
Figure 2.
Kaplan–Meier Plot of the Probability of Survival from time of transfusion to day 28 in CCP recipients (n = 73) vs matched controls (n = 73). A. All age groups. B. Age

Figure 3.

Day 28 outcomes for CCP…

Figure 3.

Day 28 outcomes for CCP recipients (n = 73) vs matched controls (n…

Figure 3.
Day 28 outcomes for CCP recipients (n = 73) vs matched controls (n = 73) presented by odds ratio and 95% confidence intervals. A. All age groups (n = 73 cases vs 73 controls). B. Age

Figure 4.

SARS-CoV-2 spike protein IgG titers…

Figure 4.

SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or…

Figure 4.
SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or D-1) and 1, 3 and 7 day after transfusion (D1, D3 and D7) in CCP recipients. (A) Age
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Figure 3.
Figure 3.
Day 28 outcomes for CCP recipients (n = 73) vs matched controls (n = 73) presented by odds ratio and 95% confidence intervals. A. All age groups (n = 73 cases vs 73 controls). B. Age

Figure 4.

SARS-CoV-2 spike protein IgG titers…

Figure 4.

SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or…

Figure 4.
SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or D-1) and 1, 3 and 7 day after transfusion (D1, D3 and D7) in CCP recipients. (A) Age
Similar articles
Cited by
References
    1. Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nature Microbiology. 2020;5(4):536–44. - PMC - PubMed
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    1. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708–20. - PMC - PubMed
    1. John Hopkins University Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering at Johns Hopkins University. Accessed Nov 16. https://coronavirus.jhu.edu/map.html.
    1. Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, et al. Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs. JAMA. 2020. - PMC - PubMed
Show all 78 references
Publication types
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 4.
Figure 4.
SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or D-1) and 1, 3 and 7 day after transfusion (D1, D3 and D7) in CCP recipients. (A) Age

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