Hyperimmune plasma for patients with severe Covid-19 has proved useless

According to the results of a large study, giving patients with severe Covid-19 plasma from convalescents does not change the course of the disease

(Image: Unsplash) The results of a branch of Remap-Cap (Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia), an important clinical study involving thousands of patients around the world, seem to put an end to the use of hyperimmune plasma for the treatment of patients with Covid. -19 serious: in most cases it is useless.

The use of hyperimmune plasma, the authors of the article published on the pages of Jama clarify, had its own reason at the beginning of the pandemic: almost no one knew none of the novel coronavirus and the available treatment alternatives were also attempts. Furthermore, the administration of plasma from convalescent patients had shown some efficacy in changing the course of other viral diseases, for example Ebola. The actual efficacy of hyperimmune plasma for Covid-19, however, has remained doubtful for a lot'. The problem - recalls Bryan McVerry, an expert at the University of Pittsburgh Medical Center who participated in the research - was that in the chaos of the emergency, with thousands of sick people and no standard of care, the therapy was administered outside of clinical trials. therefore without real patient selection criteria (not all of them were in critical condition) nor a real control population. "With these results, we can now put an end to the use of hyperimmune plasma in patients with severe Covid-19 and focus on treatments that we know work, as well as developing and testing better treatments," McVerry points out.

From Remap-Cap, in fact, it emerged that after the infusion of two hyperimmune plasma units in critical Covid patients there were no substantial differences in the progression of the disease compared to what happened in patients in the same conditions but who had received standard care. In particular, there was no difference in the probability of survival at at least three weeks without the need for respiratory support.

The researchers say they are almost certain of the uselessness of hyperimmune plasma in severe patients. However, the data showed that in immunocompromised patients the administration of hyperimmune plasma appears to have a slight benefit over standard care. However, the number is too small (only 126 patients) to draw conclusions. "It could be that patients with compromised immune systems, who are unable to develop an effective immune response, may still benefit from the antibodies present in the blood plasma of patients recovered from Covid, especially at the beginning of the disease," comments Lise Estcourt , of the University of Oxford and director of the Blood and Transplant Clinical Trials Unit of the UK's National Health Service. "This is a fact that certainly deserves investigation".

But why doesn't hyperimmune plasma work? Scientists cannot give an answer. Perhaps there are too few "quality" antibodies, or patients are now in too critical a condition to make a difference and slow the progression.

It is not correct to say that the strategy does not work in general: it is Hyperimmune plasma may have an effect on patients in better condition, even at the onset of infection. But in these cases, today, it is perhaps preferable to use monoclonal antibodies, because they are more efficient.


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