Effect of time and titer in convalescent plasma therapy for COVID-19
Paola de Candia,
Francesco Prattichizzo,
Silvia Garavelli,
Rosalba La Grotta,
Annunziata De Rosa,
Agostina Pontarelli,
Roberto Parrella,
Antonio Ceriello,
Giuseppe Matarese
Affiliations
Paola de Candia
IRCCS MultiMedica, 20138 Milano, Italy
Francesco Prattichizzo
IRCCS MultiMedica, 20138 Milano, Italy
Silvia Garavelli
Istituto per l'Endocrinologia e l'Oncologia Sperimentale, Consiglio Nazionale delle Ricerche (IEOS-CNR), 80131 Naples, Italy
Rosalba La Grotta
IRCCS MultiMedica, 20138 Milano, Italy
Annunziata De Rosa
Dipartimento di Malattie Infettive ed Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy
Agostina Pontarelli
Dipartimento di Malattie Infettive ed Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy
Roberto Parrella
Dipartimento di Malattie Infettive ed Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy
Istituto per l'Endocrinologia e l'Oncologia Sperimentale, Consiglio Nazionale delle Ricerche (IEOS-CNR), 80131 Naples, Italy; Treg Cell Lab, Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy; Corresponding author
Summary: The clinical benefit of convalescent plasma (CP) for patients with coronavirus disease (COVID)-19 is still debated. In this systematic review and meta-analysis, we selected 10 randomized clinical trials (RCTs) and 15 non-randomized studies (total number of patients = 22,591) of CP treatment and evaluated two different scenarios: (1) disease stage of plasma recipients and (2) donated plasma antibody titer, considering all-cause mortality at the latest follow-up. Our results show that, when provided at early stages of the disease, CP significantly reduced mortality: risk ratio (RR) 0.72 (0.68, 0.77), p < 0.00001, while provided in severe or critical conditions, it did not (RR: 0.94 [0.86, 1.04], p = 0.22). On the other hand, the benefit on mortality was not increased by using plasma with a high-antibody titer compared with unselected plasma. This meta-analysis might promote CP usage in patients with early-stage COVID-19 in further RCTs to maximize its benefit in decreasing mortality, especially in less affluent countries.
