COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Sarkar S, Soni KD, Khanna P Convalescent plasma is a clutch at straws in COVID-19 management! A systematic review and meta-analysis. J Med Virol. 2020 Aug 10. doi: 10.1002/jmv.26408.
Abstract

In the absence of definitive therapy for coronavirus disease (COVID-19), convalescent plasma therapy (CPT) may be a critical therapeutic option. This review was conducted to evaluate the impact of CPT in COVID-19 patients based on the publications reported to date. A robust screening of electronic databases was conducted up to 10th July 2020. Randomized controlled trials (RCTs), cohort studies, and case series with a control group evaluating the effectiveness and safety of CPT in patients with COVID-19 are included for the meta-analyses. Our search retrieved seven studies, including two RCTs and five cohort studies, with a total of 5444 patients. In patients with COVID-19, the use of CPT reduces mortality (odd's ratio [OR] 0.44; 95% CI, 0.25-0.77), increases viral clearance (OR, 11.29; 95% CI, 4.9-25.9) and improves clinically (OR, 2.06; 95% CI, 0.8 to 4.9). However, the evidence is of low quality (mortality reduction, and viral clearance), and very low quality (clinical improvement). CPT may be beneficial for reducing mortality, viral shedding and improving clinical conditions in COVID-19 patients. However, further randomized control trials (RCT) are required to substantiate the safety margin, initiation, optimal dosage, titre and duration of CPT.

Ratings
Discipline / Specialty Area Score
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

COVID-19 breeds early systematic reviews of evolving therapeutic results. Here, it is convalescent plasma therapy (an approach first used during the 'Spanish Flu' pandemic). This review is nicely balanced. After examining two randomised controlled trials (in 86 and 103 subjects), 1 case control study (185 subjects) and 5 cohort study reports (20 - 29 subjects plus one of mortality in 5000 patients given plasma), forest plots suggest reduced mortality, accelerated viral clearance, and faster clinical improvement after convalescent plasma infusion. Nevertheless, the authors rightly warn the data are potentially flawed ('low' to 'very low' quality). Much larger and better trials are underway. One hopes they will confirm and not refute these results.

Hospital Doctor/Hospitalists rater

This affirms prior understanding that convalescent plasma has the potential to improve the care of severely and critically ill COVID-19 patients, but that there is insufficient data to be confident in its efficacy, safety, and indications.

Intensivist/Critical Care rater

This is a well conducted meta analysis, though quality of evidence of the included studies was low.

Respirology/Pulmonology rater

This SR is limited to 2 RCT and few observational studies. Despite the meta analysis support a potential benefit of cPlasma, additional evidence from RCT is needed.

Respirology/Pulmonology rater

Good summary of available literature to date.

Respirology/Pulmonology rater

Systematic review and meta analysis are useless at this point of time.