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Early Convalescent Plasma Therapy and Mortality Among US Veterans Hospitalized With Nonsevere COVID-19: An Observational Analysis Emulating a Target Trial.
Cho, Kelly; Keithly, Sarah C; Kurgansky, Katherine E; Madenci, Arin L; Gerlovin, Hanna; Marucci-Wellman, Helen; Doubleday, Annie; Thomas, Eva R; Park, Yojin; Ho, Yuk-Lam; Sugimoto, Jonathan D; Moore, Kathryn P; Peterson, Alexander C; Hoag, Constance; Gupta, Kalpana; Jeans, Karen; Klote, Molly; Ramoni, Rachel; Huang, Grant D; Casas, Juan P; Gagnon, David R; Hernán, Miguel A; Smith, Nicholas L; Gaziano, J Michael.
  • Cho K; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Keithly SC; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Kurgansky KE; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Madenci AL; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Gerlovin H; Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Marucci-Wellman H; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Doubleday A; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Thomas ER; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Park Y; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Ho YL; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Sugimoto JD; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Moore KP; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Peterson AC; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
  • Hoag C; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
  • Gupta K; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Jeans K; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
  • Klote M; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
  • Ramoni R; Boston Healthcare System, Department of Veterans Affairs, Boston, Massachusetts, USA.
  • Huang GD; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
  • Casas JP; Department of Veterans Affairs Office of Research and Development, Washington, District of Columbia, USA.
  • Gagnon DR; Department of Veterans Affairs Office of Research and Development, Washington, District of Columbia, USA.
  • Hernán MA; Department of Veterans Affairs Office of Research and Development, Washington, District of Columbia, USA.
  • Smith NL; Department of Veterans Affairs Office of Research and Development, Washington, District of Columbia, USA.
  • Gaziano JM; Massachusetts Veterans Epidemiology Research and Information Center, Department of Veterans Affairs Office of Research and Development, Boston, Massachusetts, USA.
J Infect Dis ; 224(6): 967-975, 2021 09 17.
Article in English | MEDLINE | ID: covidwho-1429245
ABSTRACT

BACKGROUND:

Early convalescent plasma transfusion may reduce mortality in patients with nonsevere coronavirus disease 2019 (COVID-19).

METHODS:

This study emulates a (hypothetical) target trial using observational data from a cohort of US veterans admitted to a Department of Veterans Affairs (VA) facility between 1 May and 17 November 2020 with nonsevere COVID-19. The intervention was convalescent plasma initiated within 2 days of eligibility. Thirty-day mortality was compared using cumulative incidence curves, risk differences, and hazard ratios estimated from pooled logistic models with inverse probability weighting to adjust for confounding.

RESULTS:

Of 11 269 eligible person-trials contributed by 4755 patients, 402 trials were assigned to the convalescent plasma group. Forty and 671 deaths occurred within the plasma and nonplasma groups, respectively. The estimated 30-day mortality risk was 6.5% (95% confidence interval [CI], 4.0%-9.7%) in the plasma group and 6.2% (95% CI, 5.6%-7.0%) in the nonplasma group. The associated risk difference was 0.30% (95% CI, -2.30% to 3.60%) and the hazard ratio was 1.04 (95% CI, .64-1.62).

CONCLUSIONS:

Our target trial emulation estimated no meaningful differences in 30-day mortality between nonsevere COVID-19 patients treated and untreated with convalescent plasma. Clinical Trials Registration. NCT04545047.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Plasma / Immunization, Passive / Blood Component Transfusion / COVID-19 Subject: Plasma / Immunization, Passive / Blood Component Transfusion / COVID-19 Type of study: Risk factors Language: English Journal: J Infect Dis Clinical aspect: Etiology / Therapy Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Plasma / Immunization, Passive / Blood Component Transfusion / COVID-19 Subject: Plasma / Immunization, Passive / Blood Component Transfusion / COVID-19 Type of study: Risk factors Language: English Journal: J Infect Dis Clinical aspect: Etiology / Therapy Year: 2021
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