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Association of Convalescent Plasma Treatment With Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis.
Janiaud, Perrine; Axfors, Cathrine; Schmitt, Andreas M; Gloy, Viktoria; Ebrahimi, Fahim; Hepprich, Matthias; Smith, Emily R; Haber, Noah A; Khanna, Nina; Moher, David; Goodman, Steven N; Ioannidis, John P A; Hemkens, Lars G.
  • Janiaud P; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Axfors C; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California.
  • Schmitt AM; Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.
  • Gloy V; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Ebrahimi F; Department of Medical Oncology, University of Basel, Basel, Switzerland.
  • Hepprich M; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Smith ER; Department of Gastroenterology and Hepatology, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland.
  • Haber NA; Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.
  • Khanna N; Clinic of Endocrine and Metabolic Disorders, Cantonal Hospital Olten, Olten, Switzerland.
  • Moher D; Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC.
  • Goodman SN; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California.
  • Ioannidis JPA; Division of Infectious Diseases and Hospital Hygiene and Infection Biology Laboratory, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Hemkens LG; Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
JAMA ; 325(12): 1185-1195, 2021 03 23.
Article in English | MEDLINE | ID: covidwho-1178926
ABSTRACT
Importance Convalescent plasma is a proposed treatment for COVID-19.

Objective:

To assess clinical outcomes with convalescent plasma treatment vs placebo or standard of care in peer-reviewed and preprint publications or press releases of randomized clinical trials (RCTs). Data Sources PubMed, the Cochrane COVID-19 trial registry, and the Living Overview of Evidence platform were searched until January 29, 2021. Study Selection The RCTs selected compared any type of convalescent plasma vs placebo or standard of care for patients with confirmed or suspected COVID-19 in any treatment setting. Data Extraction and

Synthesis:

Two reviewers independently extracted data on relevant clinical outcomes, trial characteristics, and patient characteristics and used the Cochrane Risk of Bias Assessment Tool. The primary analysis included peer-reviewed publications of RCTs only, whereas the secondary analysis included all publicly available RCT data (peer-reviewed publications, preprints, and press releases). Inverse variance-weighted meta-analyses were conducted to summarize the treatment effects. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Main Outcomes and

Measures:

All-cause mortality, length of hospital stay, clinical improvement, clinical deterioration, mechanical ventilation use, and serious adverse events.

Results:

A total of 1060 patients from 4 peer-reviewed RCTs and 10 722 patients from 6 other publicly available RCTs were included. The summary risk ratio (RR) for all-cause mortality with convalescent plasma in the 4 peer-reviewed RCTs was 0.93 (95% CI, 0.63 to 1.38), the absolute risk difference was -1.21% (95% CI, -5.29% to 2.88%), and there was low certainty of the evidence due to imprecision. Across all 10 RCTs, the summary RR was 1.02 (95% CI, 0.92 to 1.12) and there was moderate certainty of the evidence due to inclusion of unpublished data. Among the peer-reviewed RCTs, the summary hazard ratio was 1.17 (95% CI, 0.07 to 20.34) for length of hospital stay, the summary RR was 0.76 (95% CI, 0.20 to 2.87) for mechanical ventilation use (the absolute risk difference for mechanical ventilation use was -2.56% [95% CI, -13.16% to 8.05%]), and there was low certainty of the evidence due to imprecision for both outcomes. Limited data on clinical improvement, clinical deterioration, and serious adverse events showed no significant differences. Conclusions and Relevance Treatment with convalescent plasma compared with placebo or standard of care was not significantly associated with a decrease in all-cause mortality or with any benefit for other clinical outcomes. The certainty of the evidence was low to moderate for all-cause mortality and low for other outcomes.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Female / Humans / Male Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2021.2747

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Female / Humans / Male Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2021.2747