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0 0.5 1 1.5 2+ Mortality -4% Improvement Relative Risk Conv. Plasma for COVID-19  Cho et al.  LATE TREATMENT Is late treatment with convalescent plasma beneficial for COVID-19? Retrospective 5,044 patients in the USA No significant difference in mortality c19early.org Cho et al., The J. Infectious Diseases, Jun 2021 Favors conv. plasma Favors control

Early Convalescent Plasma Therapy and Mortality Among US Veterans Hospitalized With Nonsevere COVID-19: An Observational Analysis Emulating a Target Trial

Cho et al., The Journal of Infectious Diseases, doi:10.1093/infdis/jiab330, NCT04545047
Jun 2021  
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Target trial emulation with 4,755 patients showing no significant difference in 30-day mortality with convalescent plasma.
risk of death, 4.0% higher, HR 1.04, p = 0.88, treatment 402, control 4,642.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cho et al., 21 Jun 2021, retrospective, USA, peer-reviewed, 24 authors, trial NCT04545047 (history). Contact: kelly.cho@va.gov.
This PaperConv. PlasmaAll
Early Convalescent Plasma Therapy and Mortality Among US Veterans Hospitalized With Nonsevere COVID-19: An Observational Analysis Emulating a Target Trial
Kelly Cho, Sarah C Keithly, Katherine E Kurgansky, Arin L Madenci, Hanna Gerlovin, Helen Marucci-Wellman, Annie Doubleday, Eva R Thomas, Yojin Park, Yuk-Lam Ho, Jonathan D Sugimoto, Kathryn P Moore, Alexander C Peterson, Constance Hoag, Kalpana Gupta, Karen Jeans, Molly Klote, Rachel Ramoni, Grant D Huang, Juan P Casas, David R Gagnon, Miguel A Hernán, Nicholas L Smith, J Michael Gaziano
The Journal of Infectious Diseases, doi:10.1093/infdis/jiab330
Background. Early convalescent plasma transfusion may reduce mortality in patients with nonsevere coronavirus disease 2019 . Methods. This study emulates a (hypothetical) target trial using observational data from a cohort of US veterans admitted to a Department of Veterans Affairs (VA) facility between 1 May and 17 November 2020 with nonsevere COVID-19. The intervention was convalescent plasma initiated within 2 days of eligibility. Thirty-day mortality was compared using cumulative incidence curves, risk differences, and hazard ratios estimated from pooled logistic models with inverse probability weighting to adjust for confounding. Results. Of 11 269 eligible person-trials contributed by 4755 patients, 402 trials were assigned to the convalescent plasma group. Forty and 671 deaths occurred within the plasma and nonplasma groups, respectively. The estimated 30-day mortality risk was 6.5% (95% confidence interval [CI], 4.0%-9.7%) in the plasma group and 6.2% (95% CI, 5.6%-7.0%) in the nonplasma group. The associated risk difference was 0.30% (95% CI, -2.30% to 3.60%) and the hazard ratio was 1.04 (95% CI, .64-1.62). Conclusions. Our target trial emulation estimated no meaningful differences in 30-day mortality between nonsevere COVID-19 patients treated and untreated with convalescent plasma. Clinical Trials Registration. NCT04545047.
Supplementary Data Supplementary materials are available at The Journal of Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. Notes Author contributions. The study was conceptualized by KC, SCK, KEK, ALM, HG, KJ, MK, GDH, JPC, DRG, MAH, NLS, and JMG. Full access to all the data in the study and responsibility for the integrity of the data and the accuracy of the data analysis are affirmed by KK and HMW. Data curation was performed by KC, SCK., KEK, ALM, HG, HMW, AD, ERT, JP, AH, and DRG. Analyses were performed by KC, SCK, KEK, ALM, HG, HMW, AD, ERT, JP, AH, ERG, MAH, NLS, and JMG.
References
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mortality in a large cohort of coronavirus ' 'disease 2019 (COVID-19) patients transfused early with convalescent ' 'plasma containing high-titer anti-severe acute respiratory syndrome ' 'coronavirus 2 (SARS-CoV-2) spike protein IgG', 'author': 'Salazar', 'doi-asserted-by': 'crossref', 'first-page': '90', 'journal-title': 'Am J Pathol', 'key': '2021091718343679700_CIT0028', 'volume': '191', 'year': '2021'}, { 'DOI': '10.1128/JCM.02005-20', 'article-title': 'Serological assays estimate highly variable SARS-CoV-2 neutralizing ' 'antibody activity in recovered COVID-19 patients', 'author': 'Luchsinger', 'doi-asserted-by': 'crossref', 'first-page': 'e02005', 'journal-title': 'J Clin Microbiol', 'key': '2021091718343679700_CIT0029', 'volume': '58', 'year': '2020'}, {'author': 'US Food and Drug Administration', 'key': '2021091718343679700_CIT0030'}, { 'DOI': '10.1016/j.ijid.2020.12.040', 'article-title': 'The collective wisdom in the COVID-19 research: comparison and ' 'synthesis of epidemiological parameter estimates in preprints and ' 'peer-reviewed articles', 'author': 'Wang', 'doi-asserted-by': 'crossref', 'first-page': '1', 'journal-title': 'Int J Infect Dis', 'key': '2021091718343679700_CIT0031', 'volume': '104', 'year': '2021'}, { 'DOI': '10.1016/j.bcmd.2021.102548', 'article-title': 'Effectiveness of convalescent plasma in Indian patients with COVID-19', 'author': 'Budhiraja', 'doi-asserted-by': 'crossref', 'first-page': '102548', 'journal-title': 'Blood Cells Mol Dis', 'key': '2021091718343679700_CIT0032', 'volume': '88', 'year': '2021'}], 'reference-count': 32, 'references-count': 32, 'relation': {}, 'resource': {'primary': {'URL': 'https://academic.oup.com/jid/article/224/6/967/6307367'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subject': ['Infectious Diseases', 'Immunology and Allergy'], 'subtitle': [], 'title': 'Early Convalescent Plasma Therapy and Mortality Among US Veterans Hospitalized With Nonsevere ' 'COVID-19: An Observational Analysis Emulating a Target Trial', 'type': 'journal-article', 'volume': '224'}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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