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0 0.5 1 1.5 2+ Mortality, day 90 19% Improvement Relative Risk Mortality, day 28 11% Improvement 0% Conv. Plasma  Bennett-Guerrero et al.  LATE TREATMENT  DB RCT Is late treatment with convalescent plasma beneficial for COVID-19? Double-blind RCT 74 patients in the USA (April 2020 - February 2021) Trial underpowered for serious outcomes Bennett-Guerrero et al., Critical Care.., Apr 2021 Favors conv. plasma Favors control

Severe Acute Respiratory Syndrome Coronavirus 2 Convalescent Plasma Versus Standard Plasma in Coronavirus Disease 2019 Infected Hospitalized Patients in New York

Bennett-Guerrero et al., Critical Care Medicine, doi:10.1097/CCM.0000000000005066, NCT04344535
Apr 2021  
  Source   PDF   All Studies   Meta AnalysisMeta
RCT 74 hospitalized patients in the USA, showing no significant difference with convalescent plasma treatment.
risk of death, 18.6% lower, RR 0.81, p = 0.75, treatment 16 of 59 (27.1%), control 5 of 15 (33.3%), NNT 16, day 90.
risk of death, 11.0% lower, RR 0.89, p = 1.00, treatment 14 of 59 (23.7%), control 4 of 15 (26.7%), NNT 34, day 28.
risk of no improvement, 0.4% lower, RR 1.00, p = 1.00, treatment 47 of 59 (79.7%), control 12 of 15 (80.0%), NNT 295.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bennett-Guerrero et al., 16 Apr 2021, Double Blind Randomized Controlled Trial, USA, peer-reviewed, 18 authors, study period 8 April, 2020 - 1 February, 2021, average treatment delay 9.0 days, trial NCT04344535 (history).
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This PaperConv. PlasmaAll
Severe Acute Respiratory Syndrome Coronavirus 2 Convalescent Plasma Versus Standard Plasma in Coronavirus Disease 2019 Infected Hospitalized Patients in New York
MD Elliott Bennett-Guerrero, PhD Jamie L Romeiser, BS Lillian R Talbot, MD Tahmeena Ahmed, MD Linda J Mamone, MD Sunitha M Singh, PhD Janet C Hearing, MD Huda Salman, BS Dishaw D Holiprosad, BS Alex T Freedenberg, PhD Jason A Carter, BS Nicholas J Browne, PhD Megan E Cosgrove, BS Margaret E Shevik, BS Laura M Generale, BSN Margaret A Andrew, MD Sharon Nachman, MD Bettina C Fries
Critical Care Medicine, doi:10.1097/ccm.0000000000005066
OBJECTIVES: Four peer-reviewed publications have reported results from randomized controlled trials of convalescent plasma for coronavirus disease 2019 infection; none were conducted in the United States nor used standard plasma as a comparator. To determine if administration of convalescent plasma to patients with coronavirus disease 2019 increases antibodies to severe acute respiratory syndrome coronavirus 2 and improves outcome. DESIGN: Double-blind randomized controlled trial. SETTING: Hospital in New York. PATIENTS: Patients with polymerase chain reaction documented coronavirus disease 2019 infection. INTERVENTIONS: Patients were randomized (4:1) to receive 2 U of convalescent plasma versus standard plasma. Antibodies to severe acute respiratory syndrome coronavirus 2 were measured in plasma units and in trial recipients. MEASUREMENTS AND MAIN RESULTS: Enrollment was terminated after emergency use authorization was granted for convalescent plasma. Seventy-four patients were randomized. At baseline, mean (sd) Acute Physiology and Chronic Health Evaluation II score (23.4 [5.6] and 22.5 [6.6]), percent of patients intubated (19% and 20%), and median (interquartile range) days from symptom onset to randomization of 9 (6-18) and 9 (6-15), were similar in the convalescent plasma versus standard plasma arms, respectively. Convalescent plasma had high neutralizing activity (median [interquartile range] titer 1:526 [1:359-1:786]) and its administration increased antibodies to severe acute respiratory syndrome coronavirus 2 by 14.4%, whereas standard plasma administration led to an 8.6% decrease (p = 0.005). No difference was observed for ventilator-free days through 28 days (primary study endpoint): median (interquartile range) of 28 (2-28) versus 28 (0-28; p = 0.86) for the convalescent plasma and standard plasma groups, respectively. A greater than or equal to 2 point improvement in the World Health Organization scale was achieved by 20% of subjects in both arms (p = 0.99). All-cause mortality through 90 days was numerically lower in the convalescent plasma versus standard plasma groups (27% vs 33%; p = 0.63) but did not achieve statistical significance. A key prespecified subgroup analysis of time to death in patients who were intubated at baseline was statistically significant; however, sample size numbers were small. CONCLUSIONS: Administration of convalescent plasma to hospitalized patients with coronavirus disease 2019 infection increased antibodies to severe acute respiratory syndrome coronavirus disease 2 but was not associated with improved outcome.
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Late treatment
is less effective
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