Deployment of convalescent plasma for the prevention and treatment of COVID-19

J Clin Invest. 2020 Jun 1;130(6):2757-2765. doi: 10.1172/JCI138745.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has spurred a global health crisis. To date, there are no proven options for prophylaxis for those who have been exposed to SARS-CoV-2, nor therapy for those who develop COVID-19. Immune (i.e., "convalescent") plasma refers to plasma that is collected from individuals following resolution of infection and development of antibodies. Passive antibody administration through transfusion of convalescent plasma may offer the only short-term strategy for conferring immediate immunity to susceptible individuals. There are numerous examples in which convalescent plasma has been used successfully as postexposure prophylaxis and/or treatment of infectious diseases, including other outbreaks of coronaviruses (e.g., SARS-1, Middle East respiratory syndrome [MERS]). Convalescent plasma has also been used in the COVID-19 pandemic; limited data from China suggest clinical benefit, including radiological resolution, reduction in viral loads, and improved survival. Globally, blood centers have robust infrastructure for undertaking collections and constructing inventories of convalescent plasma to meet the growing demand. Nonetheless, there are nuanced challenges, both regulatory and logistical, spanning donor eligibility, donor recruitment, collections, and transfusion itself. Data from rigorously controlled clinical trials of convalescent plasma are also few, underscoring the need to evaluate its use objectively for a range of indications (e.g., prevention vs. treatment) and patient populations (e.g., age, comorbid disease). We provide an overview of convalescent plasma, including evidence of benefit, regulatory considerations, logistical work flow, and proposed clinical trials, as scale-up is brought underway to mobilize this critical resource.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Antibodies, Viral / administration & dosage
  • Antibodies, Viral / blood
  • Antibodies, Viral / therapeutic use
  • Betacoronavirus* / immunology
  • Blood Donors
  • COVID-19
  • COVID-19 Serotherapy
  • Coronavirus Infections / blood
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / immunology
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / therapy*
  • Humans
  • Immunization, Passive / adverse effects
  • Investigational New Drug Application
  • Pandemics / prevention & control*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / therapy*
  • Risk Assessment
  • SARS-CoV-2
  • United States
  • United States Food and Drug Administration

Substances

  • Antibodies, Viral