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All Studies   All Outcomes    Recent:   

Effects of potent neutralizing antibodies from convalescent plasma in patients hospitalized for severe SARS-CoV-2 infection

Gharbharan et al., Nature Communications, doi:10.1038/s41467-021-23469-2, ConCoVid-19, NCT04342182
May 2021  
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Mortality 4% primary Improvement Relative Risk Time to discharge 12% Conv. Plasma  ConCoVid-19  LATE TREATMENT  RCT Is late treatment with convalescent plasma beneficial for COVID-19? RCT 86 patients in Netherlands (April - June 2020) Trial underpowered for serious outcomes c19early.org Gharbharan et al., Nature Communications, May 2021 Favorsconv. plasma Favorscontrol 0 0.5 1 1.5 2+
RCT 86 hospitalized patients, 43 treated with convalescent plasma, showing no significant differences with treatment. Authors conclude that the most likely explanation was already high antibody titers on the day of inclusion, and they recommend treating patients early.
risk of death, 3.8% lower, RR 0.96, p = 0.95, treatment 6 of 43 (14.0%), control 11 of 43 (25.6%), NNT 8.6, adjusted per study, odds ratio converted to relative risk, multivariable logistic regression, primary outcome.
time to discharge, 11.7% lower, relative time 0.88, p = 0.68, treatment 43, control 43, adjusted per study, multivariable Fine and Gray regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gharbharan et al., 27 May 2021, Randomized Controlled Trial, Netherlands, peer-reviewed, 32 authors, study period 8 April, 2020 - 14 June, 2020, average treatment delay 10.0 days, trial NCT04342182 (history) (ConCoVid-19).
This PaperConv. PlasmaAll
Effects of potent neutralizing antibodies from convalescent plasma in patients hospitalized for severe SARS-CoV-2 infection
Arvind Gharbharan, Carlijn C E Jordans, Corine Geurtsvankessel, Jan G Den Hollander, Faiz Karim, Femke P N Mollema, Janneke E Stalenhoef – Schukken, Anthonius Dofferhoff, Inge Ludwig, Adrianus Koster, Robert-Jan Hassing, Jeannet C Bos, Geert R Van Pottelberge, Imro N Vlasveld, Heidi S M Ammerlaan, Elena M Van Leeuwen – Segarceanu, Jelle Miedema, Menno Van Der Eerden, Thijs J Schrama, Grigorios Papageorgiou, Peter Te Boekhorst, Francis H Swaneveld, Yvonne M Mueller, Marco W J Schreurs, Jeroen J A Van Kampen, Barry Rockx, Nisreen M A Okba, Peter D Katsikis, Marion P G Koopmans, Bart L Haagmans, Casper Rokx, Bart J A Rijnders
Nature Communications, doi:10.1038/s41467-021-23469-2
In a randomized clinical trial of 86 hospitalized COVID-19 patients comparing standard care to treatment with 300mL convalescent plasma containing high titers of neutralizing SARS-CoV-2 antibodies, no overall clinical benefit was observed. Using a comprehensive translational approach, we unravel the virological and immunological responses following treatment to disentangle which COVID-19 patients may benefit and should be the focus of future studies. Convalescent plasma is safe, does not improve survival, has no effect on the disease course, nor does plasma enhance viral clearance in the respiratory tract, influence SARS-CoV-2 antibody development or serum proinflammatory cytokines levels. Here, we show that the vast majority of patients already had potent neutralizing SARS-CoV-2 antibodies at hospital admission and with comparable titers to carefully selected plasma donors. This resulted in the decision to terminate the trial prematurely. Treatment with convalescent plasma should be studied early in the disease course or at least preceding autologous humoral response development.
Author contributions Competing interests The Additional information Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41467-021-23469-2. Correspondence and requests for materials should be addressed to C.R. Reprints and permission information is available at http://www.nature.com/reprints Peer review Information Nature Communications thanks the anonymous reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Convalescent plasma in the management of moderate ' 'covid-19 in adults in India: open label phase II multicentre randomised ' 'controlled trial (PLACID Trial). BMJ 371, m3939 (2020).', 'journal-title': 'BMJ'}, { 'key': '23469_CR40', 'doi-asserted-by': 'publisher', 'first-page': '397', 'DOI': '10.1016/S1473-3099(11)70340-1', 'volume': '12', 'author': 'L Both', 'year': '2012', 'unstructured': 'Both, L. et al. Passive immunity in the prevention of rabies. Lancet ' 'Infect. Dis. 12, 397–407 (2012).', 'journal-title': 'Lancet Infect. Dis.'}, { 'key': '23469_CR41', 'doi-asserted-by': 'publisher', 'first-page': '1059', 'DOI': '10.1007/s10096-015-2341-x', 'volume': '34', 'author': 'R Orlando', 'year': '2015', 'unstructured': 'Orlando, R. et al. Prevention of hepatitis B virus infection: from the ' 'past to the future. Eur. J. Clin. Microbiol. Infect. Dis. 34, 1059–1070 ' '(2015).', 'journal-title': 'Eur. J. Clin. Microbiol. Infect. Dis.'}, { 'key': '23469_CR42', 'doi-asserted-by': 'crossref', 'unstructured': 'Okba, N. M. A. et al. Severe acute respiratory syndrome coronavirus ' '2-specific antibody responses in coronavirus disease 2019 patients. ' 'Emerg. Infect. Dis. 26, 1478–1488 (2020).', 'DOI': '10.3201/eid2607.200841'}, { 'key': '23469_CR43', 'doi-asserted-by': 'crossref', 'unstructured': 'Wang, X. et al. Neutralizing antibodies responses to SARS-CoV-2 in ' 'COVID-19 inpatients and convalescent patients. Clin. Infect. Dis. ' 'ciaa721 (2020).', 'DOI': '10.1101/2020.04.15.20065623'}, { 'key': '23469_CR44', 'doi-asserted-by': 'crossref', 'unstructured': 'Horby, P. et al. Dexamethasone in hospitalized patients with Covid-19 — ' 'preliminary report. N. Engl. J. Med. 384, 693–704 (2020).', 'DOI': '10.1056/NEJMoa2021436'}, { 'key': '23469_CR45', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41467-020-17317-y', 'volume': '11', 'author': 'CH GeurtsvanKessel', 'year': '2020', 'unstructured': 'GeurtsvanKessel, C. 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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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