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RESEARCH LETTER
Year : 2021  |  Volume : 38  |  Issue : 3  |  Page : 297-299  

Plasma therapy in COVID-19: All that glitters is not gold


Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, New Delhi, India

Date of Submission30-Sep-2020
Date of Acceptance05-Oct-2020
Date of Web Publication30-Apr-2021

Correspondence Address:
Nitesh Gupta
Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_798_20

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How to cite this article:
Malhotra N, Ish P, Gupta N. Plasma therapy in COVID-19: All that glitters is not gold. Lung India 2021;38:297-9

How to cite this URL:
Malhotra N, Ish P, Gupta N. Plasma therapy in COVID-19: All that glitters is not gold. Lung India [serial online] 2021 [cited 2021 Jun 16];38:297-9. Available from: https://www.lungindia.com/text.asp?2021/38/3/297/315308



Sir,

We read with great interest the review on convalescent plasma (CP) for COVID-19 by Deokar et al.[1] We wholeheartedly congratulate the authors on their concise and informative review. The article was based on a publication search up to May 5, 2020. Because no randomized controlled trials (RCTs) had been conducted on CP in COVID-19 till then, the authors had to rely on case reports and single-arm observational studies for their review. The total number of patients in the review was 27. The authors critically identified this as a limitation of their analysis. However, after May 5, 2020, a number of clinical trials have been conducted on the use of CP in COVID-19. Using the terms “COVID-19” and “plasma”, and date parameters – 05/05/2020–09/29/2020, a search was conducted on PubMed. A total of 842 entries were returned in the search. The search was further narrowed to original research articles which included controls in their study design. Three RCTs were returned, out of which two were designed for safety assessment of CP only, hence excluded. Further, two nonrandomized studies with controls in the second arm of analysis have been included in this correspondence. Lastly, the multi-centric RCT conducted on a nationwide scale in India, the PLACID trial, has also been included here. We present data results from the four studies[2],[3],[4],[5] in [Table 1].
Table 1: Summary of case–control studies on plasma therapy in COVID-19

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These studies provide a strikingly different picture to the aforementioned review. Whereas all patients in the review invariably improved after the use of CP, the controlled studies have found no difference in clinical improvement or mortality at 28 days. Even though a significantly earlier viral conversion to negative was noted, the discharge rates were not significantly better. The grounded results may be best explained by the inclusion of controls in these studies. It is also worth noting that antivirals, tocilizumab, and steroids were included in both the study and control groups, across all the four studies. In addition, all studies included severe COVID-19 patients exclusively. Taken together, these factors paint a considerably contrasting image from case reports and series that were reported earlier. At present, the Indian guidelines on COVID-19 management, issued by the Ministry of Health and Family Welfare, advise using CP as an off-label therapy. The United States Food and Drug administration has suggested using CP either strictly within the bounds of Emergency Use Authorization or in a trial, as an investigational treatment. The National Health Services in the United Kingdom is also using CP as a part of clinical trials exclusively. From our viewpoint, data from more RCTs should be reviewed before considering CP as standard therapy. Till then, precise and cautious use of CP in targeted patient population as an experimental treatment should be the practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Deokar K, Chawla G, Joel B, Dutt N. A review of convalescent plasma transfusion in COVID-19: Old wine reserved for special occasions. Lung India 2020 [Epub ahead of print]. [doi: 10.4103/lungindia.lungindia_350_20].  Back to cited text no. 1
    
2.
Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P, et al. Convalescent plasma in the management of moderate COVID-19 in India: An open-label parallel-arm phase II multicentre randomized controlled trial (PLACID Trial). BMJ 2020;371:m3939. [doi: https://doi.org/10.1136/bmj.m3939].  Back to cited text no. 2
    
3.
Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: A randomized clinical trial. JAMA 2020;324:460-70.  Back to cited text no. 3
    
4.
Omrani AS, Zaqout A, Baiou A, Daghfal J, Elkum N, Alattar RA, et al. Convalescent plasma for the treatment of patients with severe coronavirus disease 2019: A preliminary report [published online ahead of print, 2020 Sep 23]. J Med Virol. 2020;10.1002/jmv.26537. [doi:10.1002/jmv.26537].  Back to cited text no. 4
    
5.
Xia X, Kening L, Wu L, Wang Z, Zhu M, Huang B, et al. Improved clinical symptoms and mortality on severe/critical COVID-19 patients utilizing convalescent plasma transfusion. Blood 2020;136:755-9.  Back to cited text no. 5
    



 
 
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