학술논문
Safety and Efficacy of Convalescent Plasma Combined with Other Pharmaceutical Agents for Treatment of COVID-19 in Hospitalized Patients: A Systematic Review and Meta-Analysis.
Document Type
Academic Journal
Author
Franchini M; Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantua, Italy.; Focosi D; North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy.; Cruciani M; Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantua, Italy.; Joyner MJ; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA.; Pirofski LA; Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.; Senefeld JW; Department of Kinesiology and Community Healthy, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA.; Shoham S; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA 21205, USA.; Sullivan DJ; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.; Casadevall A; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Source
Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101636232 Publication Model: Electronic Cited Medium: Print ISSN: 2079-9721 (Print) Linking ISSN: 20799721 NLM ISO Abbreviation: Diseases Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2079-9721
Abstract
Plasma collected from people recovered from COVID-19 (COVID-19 convalescent plasma, CCP) was the first antibody-based therapy employed to fight the pandemic. CCP was, however, often employed in combination with other drugs, such as the antiviral remdesivir and glucocorticoids. The possible effect of such interaction has never been investigated systematically. To assess the safety and efficacy of CCP combined with other agents for treatment of patients hospitalized for COVID-19, a systematic literature search using appropriate Medical Subject Heading (MeSH) terms was performed through PubMed, EMBASE, Cochrane central, medRxiv and bioRxiv. The main outcomes considered were mortality and safety of CCP combined with other treatments versus CCP alone. This review was carried out in accordance with Cochrane methodology including risk of bias assessment and grading of the quality of evidence. Measure of treatment effect was the risk ratio (RR) together with 95% confidence intervals (CIs). A total of 11 studies (8 randomized controlled trials [RCTs] and 3 observational) were included in the systematic review, 4 studies with CCP combined with remdesivir and 6 studies with CCP combined with corticosteroids, all involving hospitalized patients. One RCT reported information on both remdesivir and steroids use with CCP. The use of CCP combined with remdesivir was associated with a significantly reduced risk of death (RR 0.74; 95% CI 0.56-0.97; p = 0.03; moderate certainty of evidence), while the use of steroids with CCP did not modify the mortality risk (RR 0.72; 95% CI 0.34-1.51; p = 0.38; very low certainty of evidence). Not enough safety data were retrieved form the systematic literature analysis. The current evidence from the literature suggests a potential beneficial effect on mortality of combined CCP plus remdesivir compared to CCP alone in hospitalized COVID-19 patients. No significant clinical interaction was found between CCP and steroids.