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van den Berg K, Glatt TN, Vermeulen M, Little F, Swanevelder R, Barrett C, Court R, Bremer M, Nyoni C, Swarts A, Mmenu C, Crede T, Kritzinger G, Naude J, Szymanski P, Cowley J, Moyo-Gwete T, Moore PL, Black J, Singh J, Bhiman JN, Baijnath P, Mody P, Malherbe J, Potgieter S, van Vuuren C, Maasdorp S, Wilkinson RJ, Louw VJ, Wasserman S. Convalescent plasma in the treatment of moderate to severe COVID-19 pneumonia: a randomized controlled trial (PROTECT-Patient Trial). Sci Rep 2022; 12:2552. [PMID: 35169169 PMCID: PMC8847351 DOI: 10.1038/s41598-022-06221-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
There is a need for effective therapy for COVID-19 pneumonia. Convalescent plasma has antiviral activity and early observational studies suggested benefit in reducing COVID-19 severity. We investigated the safety and efficacy of convalescent plasma in hospitalized patients with COVID-19 in a population with a high HIV prevalence and where few therapeutic options were available. We performed a double-blinded, multicenter, randomized controlled trial in one private and three public sector hospitals in South Africa. Adult participants with COVID-19 pneumonia requiring non-invasive oxygen were randomized 1:1 to receive a single transfusion of 200 mL of either convalescent plasma or 0.9% saline solution. The primary outcome measure was hospital discharge and/or improvement of ≥ 2 points on the World Health Organisation Blueprint Ordinal Scale for Clinical Improvement by day 28 of enrolment. The trial was stopped early for futility by the Data and Safety Monitoring Board. 103 participants, including 21 HIV positive individuals, were randomized at the time of premature trial termination: 52 in the convalescent plasma and 51 in the placebo group. The primary outcome occurred in 31 participants in the convalescent plasma group and and 32 participants in the placebo group (relative risk 1.03 (95% CI 0.77 to 1.38). Two grade 1 transfusion-related adverse events occurred. Participants who improved clinically received convalescent plasma with a higher median anti-SARS-CoV-2 neutralizing antibody titre compared with those who did not (298 versus 205 AU/mL). Our study contributes additional evidence for recommendations against the use of convalescent plasma for COVID-19 pneumonia. Safety and feasibility in this population supports future investigation for other indications.
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Affiliation(s)
- Karin van den Berg
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa.
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Tanya Nadia Glatt
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Marion Vermeulen
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Observatory, South Africa
| | - Ronel Swanevelder
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Claire Barrett
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Richard Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Marise Bremer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Cynthia Nyoni
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Avril Swarts
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Cordelia Mmenu
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thomas Crede
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Gerdien Kritzinger
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Jonathan Naude
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Patryk Szymanski
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - James Cowley
- Operations Division, Processing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Black
- Department of Medicine, Walter Sisulu University, Livingstone Hospital, Gqeberha, South Africa
| | - Jaimendra Singh
- Capital Haematology Hospital and Bone Marrow Transplant Unit, Durban, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Priyesh Mody
- Life Westville Hospital, Westville, South Africa
| | - Jacques Malherbe
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Samantha Potgieter
- Division of Infectious Diseases, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Cloete van Vuuren
- 3 Military Hospital and Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Shaun Maasdorp
- Pulmonology and Critical Care, Universitas Academic Hospital and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Francis Crick Institute, London, NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
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