In this small, uncontrolled, non-randomized case series, clinical improvement was noted in 5 critically ill patients with COVID-19 and ARDS following treatment with convalescent plasma.

Evidence Rating: 4 (Below Average)

With no specific therapeutic agents or vaccines available for COVID-19, ongoing efforts are being made to identify a treatment option that could significantly lower the relatively high mortality rate of COVID-19. One of the therapeutic strategies of interest is the administration of convalescent plasma, which previously had some promising results for the treatment of SARS and H1N1, and was recommended as an empirical treatment during the Ebola virus outbreak. Convalescent plasma therapy involves transfusion of antibody rich donor plasma from patients recovered from the illness. In this preliminary communication, researchers discuss an uncontrolled case series of 5 critically ill patients with COVID-19 an ARDS who appeared to gain significant clinical benefit from the administration of convalescent plasma. Five patients (age range, 36-73 years; 2 women) were included in the study, all of whom were requiring mechanical ventilation at time of treatment, had severe progression of disease despite antiviral treatment, and a PAO2/FIO2 of <300. In terms of treatment exposure, patients were given 2 consecutive treatments of 200-250mL of ABO-compatible convalescent plasma without cessation of antiviral therapy and standard care. Following administration, SOFA score had declined (range 1 to 4 from range 2-10) at 12 days, febrile temperatures had normalized for 4 of 5 patients in 3 days, and PAO2/FIO2 for 4 of 5 patients improved substantially. CRP, IL-6 and procalcitonin levels had decreased for 4 of 5 patients, and radiographic improvement was noted on chest CT on all patients by 3 days post-treatment.  Three of five patients were discharged from hospital, with an average length of stay of 53 days, and the other two remain stable in the hospital with a length of stay of 37 days at the time of the study. Although this was an uncontrolled case series with small sample size, and while patients were on antiviral therapy, preliminary findings suggest a benefit of convalescent plasma therapy to patients with disease courses refractory to standard care that would have otherwise had poor prognoses. Further evaluation in clinical trials may prove to be a valuable step in identifying a therapeutic option for patients with COVID-19.