Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial) (BMJ, 12th October)
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India, 39 public and private hospitals
464 adults admitted with confirmed moderate covid-19
Respiratory rate, more than 24/min
Oxygen saturation 93% or less on room air
Randomisation sequence
Convalescent plasma group (Intervention group)
n = 235
Best standard of care (Control group)
n = 229
Intervention group
Received two doses of 200 mL convalescent plasma
Detectable neutralising antibodies
Outcome measure
Progression to severe disease
All cause mortality at 28 days
Time to symptom resolution
Intervention group
Progression to severe disease death, 44 (19%)
Mortality within 28 days, 34 participants (15%)
Progression to severe disease, 17
Control group
Progression to severe disease death, 41 (18%)
Mortality within 28 days, 31 participants (14%)
Progression to severe disease, 17
Other things the same
Duration of respiratory support
Proportion of receiving invasive ventilation,
Resolution of fever and cough
Oxygen requirement
Organ failure assessment
WHO scale scores for clinical improvement
Average levels of inflammatory markers
Lactate
C reactive protein
D-dimer
Neutralising antibody titres in plasma recipients did not correlate with clinical outcomes
Better in the intervention group
Resolution of shortness of breath and
fatigue at day 7
Patients testing antigen negative at day 7
Also
Among the 38 who received invasive ventilation, only two survived until 28 days
Conclusion
Convalescent plasma was not associated with a reduction in progression to severe covid-19
or all cause mortality
High generalisability
approximates convalescent plasma use in real life settings
Professor Ian Jones, virology, Reading University
The poor performance of convalescent plasma in this trial is disappointing but not entirely surprising
Plasma is more likely to work if given very early
Researchers should to continue to conduct trials
but to do so in newly diagnosed patients.
We still do not have enough treatments for the early stage of disease to prevent severe disease and until this becomes an option, avoiding being infected with the virus remains the key message
Implications
MAB therapy
Long term immunity
Vaccination
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