Convalescent plasma to treat critically ill patients with COVID-19: framing the need for randomised clinical trials

• Published in: Critical care (London, England) Vol. 24; no. 1; pp. 1 - 449
• Main Authors: Shankar-Hari, Manu, Estcourt, Lise, Harvala, Heli, Roberts, David, Menon, David K
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 20.07.2020; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome; Antibodies; Clinical trials; Coronaviruses; COVID-19; Critical care; Ebola virus; Health aspects; Infections; Influenza; Pandemics; Patients; Plasma; Proteins; Severe acute respiratory syndrome coronavirus 2; Viral infections; Viruses
• ISSN: 1364-8535; 1364-8535; 1366-609X; 1466-609X
• DOI: 10.1186/s13054-020-03163-3

Passive immunisation with ABO blood group-compatible convalescent plasma will reduce viral burden as neutralising antibodies will binding to the viral spike protein to either prevent interaction with angiotensin-converting enzyme-2 receptor or block the conformational changes in spike protein preventing fusion to host cell membrane and provide immunomodulation. What do we know thus far about convalescent plasma therapy in COVID-19 illness? Since the recent Cochrane review that highlighted very low-certainty evidence on the effectiveness and safety of convalescent plasma in COVID-19 patients [4], Joyner and colleagues have reported safety results from a compassionate use convalescent plasma therapy programme in 5000 adults with COVID-19. Currently, it is uncertain how long these antibodies persist, but in other coronavirus infections, neutralising antibodies may persist at high titres for at least 3 months before declining [12]. [...]collection of plasma around 28 days after recovery will provide an effective product with high titres of neutralising antibodies.