30 Oct 2023 • Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (COVID-19). Minimal data are available regarding the use of convalescent plasma in patients with COVID-19–induced acute respiratory distress syndrome (ARDS). The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with COVID-19–induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28, according to research published in the New England Journal of Medicine last week.

KEY POINTS

• A total of 475 adult patients receiving invasive mechanical ventilation for less than 5 days were randomly assigned to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone in a 1:1 ratio. The primary outcome was the 28-day mortality rate.
• Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group.
• Randomization was stratified according to the time from tracheal intubation to inclusion
• The study found that administering convalescent plasma with a neutralizing antibody titer of at least 1:160 to patients with COVID-19-induced ARDS within 5 days of initiating invasive mechanical ventilation significantly reduced mortality at day 28.
• This beneficial effect was particularly prominent in patients randomized within 48 hours of ventilation initiation.
• Serious adverse events did not substantially differ between the convalescent plasma and standard care groups.

Source: NEJM | Read full story