Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma.
Chenguang Shen,Zhaoqin Wang,Fang Zhao,Yang Yang,Jinxiu Li,Jing Yuan,Fuxiang Wang,Delin Li,Delin Li,Minghui Yang,Li Xing,Jinli Wei,Haixia Xiao,Haixia Xiao,Yan Yang,Jiuxin Qu,Ling Qing,Li Chen,Zhixiang Xu,Ling Peng,Yanjie Li,Haixia Zheng,Feng Chen,Kun Huang,Yujing Jiang,Dongjing Liu,Zheng Zhang,Yingxia Liu,Lei Liu +28 more
TLDR
In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status, and these observations require evaluation in clinical trials.Abstract:
Importance Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Objective To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design, Setting, and Participants Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 Exposures Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody (IgG) binding titer greater than 1:1000 (end point dilution titer, by enzyme-linked immunosorbent assay [ELISA]) and a neutralization titer greater than 40 (end point dilution titer) that had been obtained from 5 patients who recovered from COVID-19. Convalescent plasma was administered between 10 and 22 days after admission. Main Outcomes and Measures Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion. Results All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion. Conclusions and Relevance In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.read more
Citations
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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
W. Joost Wiersinga,Andrew Rhodes,Allen C. Cheng,Sharon J. Peacock,Sharon J. Peacock,Hallie C. Prescott +5 more
TL;DR: This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19, the novel severe acute respiratory syndrome coronavirus 2 pandemic that has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease.
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Characteristics of SARS-CoV-2 and COVID-19
TL;DR: The basic virology of SARS-CoV-2 is described, including genomic characteristics and receptor use, highlighting its key difference from previously known coronaviruses.
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Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial.
Yeming Wang,Yeming Wang,Dingyu Zhang,Guanhua Du,Ronghui Du,Jianping Zhao,Yang Jin,Shouzhi Fu,Ling Gao,Zhenshun Cheng,Qiaofa Lu,Yi Hu,Guangwei Luo,Ke Wang,Yang Lu,Huadong Li,Shuzhen Wang,Shunan Ruan,Chengqing Yang,Chunlin Mei,Yi Wang,Dan Ding,Feng Wu,Xin Tang,Xianzhi Ye,Yingchun Ye,Bing Liu,Jie Yang,Wen Yin,Aili Wang,Guohui Fan,Fei Zhou,Zhibo Liu,Xiaoying Gu,Jiuyang Xu,Lianhan Shang,Lianhan Shang,Yi Zhang,Lianjun Cao,Guo Tingting,Yan Wan,Hong Qin,Yushen Jiang,Thomas Jaki,Thomas Jaki,Frederick G. Hayden,Peter Horby,Bin Cao,Chen Wang +48 more
TL;DR: In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits, however, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies.
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Compassionate Use of Remdesivir for Patients with Severe Covid-19.
Jonathan Grein,Norio Ohmagari,Daniel Shin,George Diaz,Erika Asperges,Antonella Castagna,Torsten Feldt,Gary M. Green,Margaret L. Green,François-Xavier Lescure,Emanuele Nicastri,Rentaro Oda,Kikuo Yo,Eugenia Quiros-Roldan,Alex Studemeister,John Redinski,Seema Ahmed,Jorge Bernett,Daniel Chelliah,Danny Chen,Shingo Chihara,Stuart H. Cohen,Jennifer Cunningham,Antonella D’Arminio Monforte,Saad Ismail,Hideaki Kato,Giuseppe Lapadula,Erwan L’Her,Toshitaka Maeno,Sumit Majumder,Marco Massari,Marta Mora-Rillo,Yoshikazu Mutoh,Duc Nguyen,Ewa Verweij,Alexander Zoufaly,Anu Osinusi,Adam DeZure,Yang Zhao,Lijie Zhong,Anand Chokkalingam,Emon Elboudwarej,Laura Telep,Leighann Timbs,Ilana Henne,Scott Sellers,Huyen Cao,Susanna K. Tan,Lucinda Winterbourne,Polly Desai,Robertino Mera,Anuj Gaggar,Robert P. Myers,Diana M. Brainard,Richard Childs,Timothy Flanigan +55 more
TL;DR: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients, and Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesavir therapy.
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Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review.
TL;DR: The COVID-19 pandemic represents the greatest global public health crisis of this generation and, potentially, since the pandemic influenza outbreak of 1918 and both the need and capability to produce high-quality evidence even in the middle of a pandemic.
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