The Association for the Advancement of Blood and Biotherapies (AABB) publishes clinical practice guidelines for the appropriate use of COVID-19 convalescent plasma
- Abstract: https://www.acpjournals.org/doi/10.7326/M22-1079
- Publisher: https://www.acpjournals.org/doi/10.7326/M22-2329
The Association for the Advancement of Blood and Biotherapies (AABB) has published clinical practice guidelines for the appropriate use of COVID-19 convalescent plasma (CCP) in hospital settings and outpatients . Based on two live systematic reviews of randomized controlled trials (RCTs), the guidelines provide five specific recommendations for the treatment of patients with COVID-19 and suggest that CCP is most effective when transfused with high neutralizing titers to infected patients soon after. of the onset of symptoms. The guidelines are published in Annals of Internal Medicine .
Recommendation 1 (Outpatient): The AABB suggests CCP transfusion in addition to the usual standard of care for outpatients with COVID-19 who are at high risk of disease progression (weak recommendation, moderate-certainty evidence). Recommendation 2 (Hospitalized patient): The AABB recommends against CCP transfusion for unselected hospitalized people with moderate or severe disease (strong recommendation, high-certainty evidence). This recommendation does not apply to immunosuppressed patients or those who lack antibodies against SARS-CoV-2. Recommendation 3 (Hospitalized patient): The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 who do not have SARS-CoV-2 antibodies detected on admission (weak recommendation, low-certainty evidence). Recommendation 4 (Hospitalized patient): The AABB suggests CCP transfusion in addition to the usual standard of care for hospitalized patients with COVID-19 and pre-existing immunosuppression (weak recommendation, low-certainty evidence). Recommendation 5 (Prophylaxis): The AABB suggests against prophylactic CCP transfusion for uninfected people with close contact exposure to a person with COVID-19 (weak recommendation, low-certainty evidence). Good Clinical Practice Statement: CCP is most effective when transfused with high neutralizing titers to infected patients soon after symptom onset. |
Comments
COVID-19 convalescent plasma (CCP) has emerged as a potential COVID-19 treatment. However, the data and recommendations from the meta-analysis are limited. A team led by the AABB Clinical Transfusion Medicine committee studied published research to inform the guidelines. The two live systematic reviews of RCTs evaluating CCP from January 1, 2019 to January 26, 2022 included 33 RCTs evaluating 21,916 participants.
Based on the data, the AABB recommends that non-hospitalized patients at high risk of disease progression receive a CCP transfusion in addition to the usual standard of care.
The AABB also advises against CCP transfusion in hospitalized patients with moderate or severe illness, but says CCP transfusion should be added to the usual standard of care for those who did not have SARS CoV-2 antibodies detected on admission and for those with pre-existing immunosuppression.
The AABB recommends against prophylactic CCP transfusions for uninfected individuals with close contact exposure to a person with COVID-19. The AABB summarized its findings with a good clinical practice statement: CCP is most effective when transfused with high neutralizing titers soon after symptom onset.
The researchers summarized the results using the GRADE ( Grading of Recommendations Assessment, Development and Evaluation ) method. The recommendations were made under the assumption that patients would highly value avoiding the risks of disease progression, morbidity, and mortality from COVID-19. Therefore, when the data suggested that there was limited harm from CCP transfusions and that there was a benefit to CCP, the panel was prepared to make recommendations for CCP.
The authors say there are several advantages of CCP. While SARS-CoV-2 evolves and new variants of concern (VOCs) emerge that can evade monoclonal antibodies, high-titer CCP remains effective. CCP is also relatively easy to harvest, making it a less expensive therapeutic option than other passive antibody therapies.
