Convalescent Plasma Therapy Doesn’t Help Critically Ill COVID-19 Patients

In the earliest days of the  COVID-19 pandemic , the medical community turned to a century-old treatment: Take blood from recovered patients and give it to the sick. The hypothesis was that components in the so-called “convalescent plasma” that fought off the disease once could do it again, something that has worked in other diseases, such as  Ebola .

Today, an international research team, which included  University of Pittsburgh School of Medicine  physician-scientists and  UPMC  patients, effectively put an end to that practice with a clinical trial that concluded convalescent plasma is “futile” as a COVID-19 treatment for most critically ill patients. The results are published in  JAMA  concurrent with presentation at the  European Society of Intensive Care Medicine ’s annual meeting.

The findings are the latest from  REMAP-CAP  (Randomised, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia), which has enrolled thousands of patients in hundreds of hospitals around the world to quickly determine what COVID-19 treatments work best in which patients. To date, more than  400 UPMC patients have been enrolled . Among its discoveries, REMAP-CAP has shown that  inexpensive steroids are effective in helping critically ill patients , while  blood thinners help the moderately ill .

In the convalescent plasma trial, REMAP-CAP enrolled 2,011 adults hospitalized with severe COVID-19. They were randomized to either receive two units of convalescent plasma or no plasma and followed to see if the likelihood of surviving at least three weeks without needing organ support, such as a ventilator, differed based on whether they were treated or not.

The trial concluded for futility when enough data was collected to say with greater than 99% certainty that convalescent plasma did not help critically ill COVID-19 patients.

However, the results followed a slightly different pattern for the 126 patients who were immunocompromised. This group appeared to do slightly better with the convalescent plasma treatment compared to the standard treatment, but the number of patients was too small to make a definitive statement.

The researchers could not determine why convalescent plasma did not improve outcomes in most critically ill patients. 

Reference:  Writing Committee for the REMAP-CAP Investigators. Effect of convalescent plasma on organ support–free days in critically ill patients with COVID-19: A randomized clinical trial. JAMA . 2021. doi: 10.1001/jama.2021.18178

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