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0 0.5 1 1.5 2+ Mortality, day 90 -4% Improvement Relative Risk Mortality, day 30 -17% Conv. Plasma  Kasten et al.  LATE TREATMENT Is late treatment with convalescent plasma beneficial for COVID-19? Retrospective 50 patients in the USA (September 2020 - February 2021) Study underpowered to detect differences c19early.org Kasten et al., Scientific Reports, Dec 2023 Favors conv. plasma Favors control

COVID-19 outcome is not affected by anti-CD20 or high-titer convalescent plasma in immunosuppressed patients

Kasten et al., Scientific Reports, doi:10.1038/s41598-023-48145-x, NCT04884477
Dec 2023  
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Retrospective 144 immunocompromised patients treated with anti-CD20 therapy prior to contracting COVID-19. Among 50 patients hospitalized within 14 days, administration of high-titer convalescent plasma in the first 14 days was not associated with improved outcomes.
risk of death, 3.8% higher, RR 1.04, p = 1.00, treatment 7 of 19 (36.8%), control 11 of 31 (35.5%), day 90.
risk of death, 16.5% higher, RR 1.17, p = 1.00, treatment 5 of 19 (26.3%), control 7 of 31 (22.6%), day 30.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kasten et al., 1 Dec 2023, retrospective, USA, peer-reviewed, median age 63.6, 13 authors, study period 1 September, 2020 - 28 February, 2021, trial NCT04884477 (history). Contact: mkasten@mayo.edu, bauer.philippe@mayo.edu.
This PaperConv. PlasmaAll
COVID-19 outcome is not affected by anti-CD20 or high-titer convalescent plasma in immunosuppressed patients
Mary J Kasten, Brian D Lahr, Anusha Parisapogu, Zachary A Yetmar, John C O’horo, Robert Orenstein, Pablo Moreno Franco, Raymund R Razonable, Paschalis Vergidis, Aditya S Shah, Mark J Enzler, David J Inwards, Philippe R Bauer
Scientific Reports, doi:10.1038/s41598-023-48145-x
The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma in the treatment of Coronavirus Disease 2019 (COVID-19) in immunosuppressed individuals remains controversial. We describe the course of COVID-19 in patients who had received anti-CD20 therapy within the 3 years prior to infection. We compared outcomes between those treated with and those not treated with high titer SARS-CoV2 convalescent plasma. We identified 144 adults treated at Mayo clinic sites who had received anti-CD20 therapies within a median of 5.9 months prior to the COVID-19 index date. About one-third (34.7%) were hospitalized within 14 days and nearly half (47.9%) within 90 days. COVID-19 directed therapy included anti-spike monoclonal antibodies (n = 30, 20.8%), and, among those hospitalized within 14 days (n = 50), remdesivir (n = 45, 90.0%), glucocorticoids (n = 36, 72.0%) and convalescent plasma (n = 24, 48.0%). The duration from receipt of last dose of anti-CD20 therapy did not correlate with outcomes. The overall 90-day mortality rate was 14.7%. Administration of convalescent plasma within 14 days of the COVID-19 diagnosis was not significantly associated with any study outcome. Further study of COVID-19 in CD20-depleted individuals is needed focusing on the early administration of new and potentially combination antiviral agents, associated or not with vaccine-boosted convalescent plasma.
Author contributions Authors M.J.K., B.D.L., Z.A.Y., J.C.O., M.J.E., D.J.I., R.R.R., A.S.S., P.V., P.R.B. were all involved with conception and design of the study.Authors M.J.K., A.P., Z.A.Y., J.C.O., M.J.E., P.M.F., R.O., R.R.R., A.S.S., P.V., P.R.B. were all involved in data acquisition.Authors M.J.K., B.D.L., A.P., Z.A.Y., J.C.O., M.J.E., D.J.I., P.M.F., R.O., R.R.R., A.S.S., P.V., P.R.B. were all involved in data interpetation.All Authors M.J.K., B.D.L., A.P., Z.A.Y., J.C.O., M.J.E., D.J.I., P.M.F., R.O., R.R.R., A.S.S., P.V., P.R.B. were involved with drafting and approving the manuscript. Competing interests Additional information Supplementary Information The online version contains supplementary material available at https:// doi. org/
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Late treatment
is less effective
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