Study renews hope for convalescent plasma to treat COVID-19

PROVIDENCE – The treatment is carried out in human bodies, instead of a laboratory: the blood plasma of people who have recovered from COVID-19.

So-called convalescent plasma has also been shown to be medically uncertain, with a scientific consensus that appears to change as often as the dietary benefits of eggs: likely to die after receiving blood plasma from donors cured of the virus.

But a new study by researchers across the country, including Rhode Island, is reviving hope of using convalescent plasma. One of the keys is timing: patients must get it before they are hospitalized. The study showed a 54 percent reduction in the risk of hospitalization in people who received convalescent plasma compared to those who received placebo.

“This is an important treatment that can keep you from going to the hospital,” said Dr. Adam Levine, an emergency physician at Lifespan who led the study in Rhode Island. “It’s important as an individual. It is also important in terms of reducing hospitalizations to avoid overloading the health system.

Rhode Island was one of the primary centers for the Johns Hopkins University-based study, which recruited 1,181 patients across the country. The study is available on the MedRxiv website as a pre-print, which means it hasn’t been peer reviewed.

In Rhode Island, adults who started showing symptoms of COVID-19 within eight days entered one of two emergency rooms at Hasbro Children’s Hospital to receive the infusion treatment. (The children’s hospital has been significantly less busy throughout the pandemic because children are much less susceptible than the elderly to COVID-19, and because limits on social and sports activities have kept children from unwinding. to injure.)

The study showed that providing treatment to people before they are hospitalized can help, although other studies have shown that it wouldn’t make a difference until patients are in the hospital. It makes medical sense, Levine said: By the time the patients are in the hospital, the virus itself had already taken its toll and the cascade of inflammation had begun. Antibodies in donor blood would no longer be of much use. Instead, patients need something to deal with the inflammation and associated complications.

But getting it to people early would give their bodies a chance to fight off the virus, pushing it away before it can do its most damage.

Another key, Levine said: They used “high titer” plasma, or plasma rich in antibodies. Some people recovering from COVID have high titer plasma and others do not. Levine said early indications show that people who are vaccinated, but have breakthrough infections, have blood with very high levels of antibodies.

The study is particularly important in the context of Omicron and other variants of the virus that causes COVID-19, Levine said. Omicron in particular has been shown to be resistant to some of the monoclonal antibodies made in the laboratory. But when someone gets sick with Omicron, their body makes antibodies specifically against Omicron. It might help people who get the same variant, or new ones as they arise. Our bodies, in other words, retool to help fight the virus faster than researchers in a lab can.

This is potentially good news not only in the United States, but in parts of the world with less access to scarce resources.

Levine noted that on Tuesday only the United States Food and Drug Administration, in an announcement that did not attract much attention, updated its authorization for the use of convalescent plasma to include outpatient use. , in addition to hospitalizations. The authorization is intended for people who are immunocompromised. This can include large swathes of people vulnerable to the disease, such as those with heart disease, diabetes, or the elderly.

Levine said policymakers in Rhode Island could use convalescent plasma under the same conditions he currently uses lab-made monoclonal antibodies. They require the same setup: a transfusion site and a place to sit for an hour for observation.

Levine said the medical community must also redouble their efforts to get people who have recovered from COVID-19 to donate their plasma, an effort that failed when it proved ineffective in people already hospitalized.

“Now we have to increase that again,” Levine said.

Brian Amaral can be reached at [email protected]. Follow him on twitter @ bamaral44.