28 Jan COVID-19: Convalescent Plasma Not Uniformly Effective for All Patients
MedicalResearch.com Interview with:
Eva Petkova, PhD
Professor, NYU School of Medicine
Department of Population Health
Division of Biostatistics
Department of Child and Adolescent Psychiatry, New York, NY 10016
Senior Scientist, Nathan Kline Institute of Psychiatric Research, Orangeburg, NY 10962
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The COMPILE study is based on real-time collection of individual patient data from 8 international completed, terminated early and ongoing randomized clinical trials testing the efficacy of convalescent plasma for the treatment of hospitalized patients with COVID-19. Recruitment covered the period from March 2020 to March 2021 in Asia, Europe, North and South America. Total of 2369 patients were enrolled and data from 2341 patients were used in the analysis. COMPILE, the largest study of convalescent plasma for hospitalized COVID-19 patients to date, provided robust information on a diverse patient population, which allowed rigorous evaluation of questions related to convalescent plasma efficacy.
The main findings are that convalescent plasma might have only a moderate efficacy on average, but that there is a huge heterogeneity in the benefits for individual patients.
MedicalResearch.com: What should readers take away from your report?
Two points are very important.
- First, is the recognition that a treatment is not uniformly effective for all patients. For example, the COMPILE study showed that convalescent plasma is most effective for patients at the earlier stages of COVID-19, i.e., when patients do not need oxygen support. Similarly, patients with pre-existing health conditions that compromise their ability to rapidly produce antibodies to the COVID-19 virus (e.g., people with diabetes) benefit more from the treatment than those without any pre-existing health problems.
- Second, in order to be able to reliably identify groups of patients who benefit from a given treatment and groups that might be harmed from the treatment, large samples from diverse patient populations are needed. The traditional design and initiation of such large studies are lengthily endeavors and possibly infeasible during pandemics. The COMPILE study design is a novel alternative allowing for rapid data collection and conclusions, that critically depends on the good will for cooperation between researchers and open sharing of unpublished data for the bettering of human health.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: In the context of COVID-19 convalescent plasma, further research needs to investigate at least the following important effects on patients’ outcomes: the effect of donors’ plasma characteristics; the effect of patients’ pre-treatment antibodies status; the effect of concomitant medications for COVID-19 (e.g., older drugs such as remdesivir and dexamethasone, and more recent drugs, such as the antivirals developed by Pfizer and Merck, as well as vaccination status). It is possible that convalescent plasma is most effective only in the absence of other drug treatments, but this needs to be studied in preparation for future pandemic events.
MedicalResearch.com: Is there anything else you would like to add?
Response: A companion article, based on data from the COMPILE study and published simultaneously “Development and validation of a treatment benefit index to identify hospitalized patients with COVID-19 who may benefit from convalescent plasma” proposes a score that indicates what is the expected benefit from treatment with convalescent plasma compared to treatment without convalescent plasma for individual patients. This treatment benefit index (TBI) uses simple baseline patient characteristics and can be easily computed. In fact, the paper offers a link to a calculator of the TBI that is freely available for desktops and mobile computer devises at https://covid-convalescentplasma-tbi-calc.org/
The development of such tools require large datasets and the COVID-19 convalescent plasma (CCP) TBI would not have been possible to develop without the COMPILE study. The TBI developed on the COMPILE data, was validates on 4 external data sets – another demonstrations of the collaborative spirit among researchers during the COVID-19 pandemic.
Troxel AB, Petkova E, Goldfeld K, et al. Association of Convalescent Plasma Treatment With Clinical Status in Patients Hospitalized With COVID-19: A Meta-analysis. JAMA Netw Open. 2022;5(1):e2147331. doi:10.1001/jamanetworkopen.2021.47331
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