RESEARCH PAPER
Efficacy and harms of convalescent plasma for treatment of hospitalized COVID-19 patients: a systematic review and meta-analysis
Alejandro Piscoya 1, 2  
,   Luis Fernando Ng-Sueng 1, 3  
,   Angela Parra del Riego 4  
,   Renato Cerna-Viacava 4  
,   Vinay Pasupuleti 5  
,   Priyaleela Thota 6  
,   Yuani M Roman 7  
,   Adrian V Hernandez 7  
 
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1
Unidad de Revisiones Sistemáticas y Meta-análisis, Guías de Práctica Clínica y Evaluaciones de Tecnologías Sanitarias, Universidad San Ignacio de Loyola, Peru
2
Hospital Guillermo Kaelin de la Fuente, Peru
3
Department of Internal Medicine, Henry Ford Hospital, United States
4
Universidad Peruana de Ciencias Aplicadas, Peru
5
MedErgy Health Group Inc, United States
6
Hemex Health Inc, United States
7
University of Connecticut, United States
CORRESPONDING AUTHOR
Adrian V Hernandez   

University of Connecticut, 06269, Storra, United States
Submission date: 2020-10-24
Final revision date: 2020-12-24
Acceptance date: 2021-01-17
Online publication date: 2021-02-18
 
 
KEYWORDS
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ABSTRACT
Introduction:
We systematically reviewed benefits and harms of convalescent plasma (CP) in hospitalized COVID-19 patients.

Material and methods:
Randomized controlled trials (RCTs) and observational studies assessing CP effects on hospitalized, adult COVID-19 patients were searched until November 24, 2020. We assessed risk of bias (RoB) using Cochrane RoB 2.0 and ROBINS-I tools. Inverse variance random effect meta-analyses were performed. Quality of evidence was evaluated using GRADE methodology. Primary outcomes were all-cause mortality, clinical improvement, and adverse events.

Results:
Five RCTs (n = 1067) and 6 cohorts (n = 881) were included. Three and 1 RCTs had some concerns and high RoB, respectively; and there was serious RoB in all cohorts. Convalescent plasma did not reduce all-cause mortality in RCTs of severe (RR = 0.60, 95% CI: 0.33–1.10) or moderate (RR = 0.60, 95% CI: 0.09–3.86) COVID-19 vs. standard of care (SOC); CP reduced all-cause mortality vs. SOC in cohorts (RR = 0.66, 95% CI: 0.49–0.91). Convalescent plasma did not reduce invasive ventilation vs. SOC in moderate disease (RR = 0.85, 95% CI: 0.47–1.55). In comparison to placebo + SOC, CP did not affect all-cause mortality (RR = 0.75, 95% CI: 0.48–1.16) or clinical improvement (HR = 1.07, 95% CI: 0.82–1.40) in severe patients. Adverse and serious adverse events were scarce, similar between CP and controls. Quality of evidence was low or very low for most outcomes.

Conclusions:
In comparison to SOC or placebo + SOC, CP did not reduce all-cause mortality in RCTs of hospitalized COVID-19 patients. Convalescent plasma did not have an effect on other clinical or safety outcomes. Until now there is no good quality evidence to recommend CP for hospitalized COVID-19 patients.

eISSN:1896-9151
ISSN:1734-1922