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Research

Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis

Niveditha Devasenapathy, Zhikang Ye, Mark Loeb, Fang Fang, Borna Tadayon Najafabadi, Yingqi Xiao, Rachel Couban, Philippe Bégin and Gordon Guyatt
CMAJ July 06, 2020 192 (27) E745-E755; DOI: https://doi.org/10.1503/cmaj.200642
Niveditha Devasenapathy
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Zhikang Ye
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Mark Loeb
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Fang Fang
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Borna Tadayon Najafabadi
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Yingqi Xiao
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Rachel Couban
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Philippe Bégin
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Gordon Guyatt
Indian Institute of Public Health-Delhi (Devasenapathy), Public Health Foundation of India, Gurgaon, Haryana, India; Department of Health Research Methods, Evidence and Impact (Ye, Loeb, Fang, Tadayon Najafabadi, Xiao, Couban, Guyatt), McMaster University, Hamilton, Ont.; Guangzhou University of Chinese Medicine (Fang), Guangzhou, Guangdong, China; West China School of Nursing and West China Hospital (Xiao), Sichuan University, Chengdu, Sichuan, China; Department of Medicine (Bégin), Université de Montréal, Que.
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Abstract

BACKGROUND: The safety and efficacy of convalescent plasma in severe coronavirus disease 2019 (COVID-19) remain uncertain. To support a guideline on COVID-19 management, we conducted a systematic review and meta-analysis of convalescent plasma in COVID-19 and other severe respiratory viral infections.

METHODS: In March 2020, we searched international and Chinese biomedical literature databases, clinical trial registries and prepublication sources for randomized controlled trials (RCTs) and nonrandomized studies comparing patients receiving and not receiving convalescent plasma. We included patients with acute coronavirus, influenza and Ebola virus infections. We conducted a meta-analysis using random-effects models and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS: Of 1099 unique records, 6 studies were eligible, and none of these included patients with COVID-19. One nonrandomized study (n = 40) on convalescent plasma in severe acute respiratory syndrome coronavirus (SARS-CoV) provided uninformative results regarding mortality (relative risk [RR] 0.10, 95% confidence interval [CI] CI 0.01 to 1.70). Pooled estimates from 4 RCTs on influenza (n = 572) showed no convincing effects on deaths (4 RCTs, RR 0.94, 95% CI 0.49 to 1.81), complete recovery (2 RCTs, odds ratio 1.04, 95% CI 0.69 to 1.64) or length of stay (3 RCTs, mean difference −1.62, 95% CI −3.82 to 0.58, d). The quality of evidence was very low for all efficacy outcomes. Convalescent plasma caused few or no serious adverse events in influenza RCTs (RR 0.85, 95% CI 0.56 to 1.29, low-quality evidence).

INTERPRETATION: Studies of non-COVID-19 severe respiratory viral infections provide indirect, very low-quality evidence that raises the possibility that convalescent plasma has minimal or no benefit in the treatment of COVID-19 and low-quality evidence that it does not cause serious adverse events.

See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.200648

  • Accepted May 1, 2020.
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Canadian Medical Association Journal: 192 (27)
CMAJ
Vol. 192, Issue 27
6 Jul 2020
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Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis
Niveditha Devasenapathy, Zhikang Ye, Mark Loeb, Fang Fang, Borna Tadayon Najafabadi, Yingqi Xiao, Rachel Couban, Philippe Bégin, Gordon Guyatt
CMAJ Jul 2020, 192 (27) E745-E755; DOI: 10.1503/cmaj.200642

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Efficacy and safety of convalescent plasma for severe COVID-19 based on evidence in other severe respiratory viral infections: a systematic review and meta-analysis
Niveditha Devasenapathy, Zhikang Ye, Mark Loeb, Fang Fang, Borna Tadayon Najafabadi, Yingqi Xiao, Rachel Couban, Philippe Bégin, Gordon Guyatt
CMAJ Jul 2020, 192 (27) E745-E755; DOI: 10.1503/cmaj.200642
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