Br J Anaesth . Convalescent plasma for COVID-19: a meta-analysis, trial sequential analysis, and meta-regression

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Br J Anaesth


. 2021 Aug 30;S0007-0912(21)00546-8.
doi: 10.1016/j.bja.2021.07.033. Online ahead of print.
Convalescent plasma for COVID-19: a meta-analysis, trial sequential analysis, and meta-regression


Timothy A C Snow ¹ , Naveed Saleem ¹ , Gareth Ambler ² , Eleni Nastouli ³ , Laura E McCoy ⁴ , Mervyn Singer ¹ , Nishkantha Arulkumaran ⁵



Affiliations

• PMID: 34579942
• DOI: 10.1016/j.bja.2021.07.033

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies, particularly those preventing interaction between the viral spike receptor-binding domain and the host angiotensin-converting enzyme 2 receptor, may prevent viral entry into host cells and disease progression.
Methods: We performed a systematic review, meta-analysis, trial sequential analysis (TSA), and meta-regression of RCTs to evaluate the benefit of convalescent plasma for COVID-19. The primary outcome was 28-30 day mortality. Secondary outcomes included need for mechanical ventilation and ICU admission. Data sources were PubMed, Embase, MedRxiv, and the Cochrane library on July 2, 2021.
Results: We identified 17 RCTs that recruited 15 587 patients with 8027 (51.5%) allocated to receive convalescent plasma. Convalescent plasma use was not associated with a mortality benefit (24.7% vs 25.5%; odds ratio [OR]=0.94 [0.85-1.04]; P=0.23; I²=4%; TSA adjusted confidence interval [CI], 0.84-1.05), or reduction in need for mechanical ventilation (15.7% vs 15.4%; OR=1.01 [0.92-1.11]; P=0.82; I²=0%; TSA adjusted CI, 0.91-1.13), or ICU admission (22.4% vs 16.7%; OR=0.80 [0.21-3.09]; P=0.75; I²=63%; TSA adjusted CI, 0.0-196.05). Meta-regression did not reveal association with titre of convalescent plasma, timing of administration, or risk of death and treatment effect (P>0.05). Risk of bias was high in most studies.
Conclusions: In patients with COVID-19, there was no clear mortality benefit associated with convalescent plasma treatment. In patients with mild disease, convalescent plasma did not prevent either the need for mechanical ventilation or ICU admission.