Title: Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults
Authors: Libster et al., 2021
Journal: The New England Journal of Medicine
Date: 01/06/2021
Tags: Plasma therapy, IgG titers
Reviewer: NC
Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2033700

Summary: This study assessed the effects of providing convalescent plasma with IgG titers against SARS-CoV-2 to adults > 65 years with Covid-19. The researchers conducted a randomized, double-blind, placebo-controlled trial and administered the convalescent plasma within 72 hours of Covid-19 symptom onset. A total of 160 symptomatic patients meeting the eligibility criteria were randomized into the treatment groups (i.e., placebo or convalescent plasma). Severe respiratory disease served as the primary end point. Secondary end points included ICU admission, critical systemic illness, life-threatening respiratory illness, death, or any combination of these. The results showed that a larger percentage of the participants who received the placebo developed severe respiratory disease compared to the intention-to-treat population (RR = 0.52; 95% CI: 0.29 - 0.94). The researchers also reported a dose-dependent IgG effect in convalescent plasma, suggesting that the IgG antibodies aid in preventing the exacerbation of Covid-19 symptoms. This study proposes that convalescent plasma against SARS-CoV-2 leads to a decrease in the development of critical Covid-19 symptoms in older adults.

Limitations: A small sample from a single population limits the interpretability of the results. The three-day window of treatment may not apply to most people who become infected and symptomatic with SARS-CoV-2. Severity of symptoms at time of enrollment was not noted. The placebo group had a marginally higher average age with the majority being 75 years or older.

Takeaways: This was one of the first clinical trials evaluating the efficacy of convalescent plasma in treating COVID-19 in older adults. This option is relatively inexpensive compared to monoclonal antibody treatments. Future multi-site studies are needed to replicate the findings of this study.