BACKGROUND Passive immunotherapy with convalescent plasma (CP) is a potential treatment for COVID-19. Evidence from controlled clinical trials is inconclusive.METHODS We conducted a randomized, open-label, controlled clinical trial at 27 hospitals in Spain. Patients had to be admitted for COVID-19 pneumonia within 7 days from symptom onset and not on mechanical ventilation or high-flow oxygen devices. Patients were randomized 1:1 to treatment with CP in addition to standard of care (SOC) or to the control arm receiving only SOC. The primary endpoint was the proportion of patients in categories 5 (noninvasive ventilation or high-flow oxygen), 6 (invasive mechanical ventilation or extracorporeal membrane oxygenation [ECMO]), or 7 (death) at 14 days. Primary analysis was performed in the intention-to-treat population.RESULTS Between April 4, 2020, and February 5, 2021, 350 patients were randomly assigned to either CP (n = 179) or SOC (n = 171). At 14 days, proportion of patients in categories 5, 6, or 7 was 11.7% in the CP group versus 16.4% in the control group (P = 0.205). The difference was greater at 28 days, with 8.4% of patients in categories 5–7 in the CP group versus 17.0% in the control group (P = 0.021). The difference in overall survival did not reach statistical significance (HR 0.46, 95% CI 0.19–1.14, log-rank P = 0.087).CONCLUSION CP showed a significant benefit in preventing progression to noninvasive ventilation or high-flow oxygen, invasive mechanical ventilation or ECMO, or death at 28 days. The effect on the predefined primary endpoint at 14 days and the effect on overall survival were not statistically significant.TRIAL REGISTRATION Clinicaltrials.gov, NCT04345523.FUNDING Government of Spain, Instituto de Salud Carlos III.
Cristina Avendaño-Solá, Antonio Ramos-Martínez, Elena Muñez-Rubio, Belen Ruiz-Antorán, Rosa Malo de Molina, Ferran Torres, Ana Fernández-Cruz, Jorge Calderón-Parra, Concepcion Payares-Herrera, Alberto Díaz de Santiago, Irene Romera-Martínez, Ilduara Pintos, Jaime Lora-Tamayo, Mikel Mancheño-Losa, Maria L. Paciello, A.L. Martínez-González, Julia Vidán-Estévez, Maria J. Nuñez-Orantos, Maria Isabel Saez-Serrano, Maria L. Porras-Leal, Maria C. Jarilla-Fernández, Paula Villares, Jaime Pérez de Oteyza, Ascension Ramos-Garrido, Lydia Blanco, Maria E. Madrigal-Sánchez, Martin Rubio-Batllés, Ana Velasco-Iglesias, José R. Paño-Pardo, J.A. Moreno-Chulilla, Eduardo Muñiz-Díaz, Inmaculada Casas-Flecha, Mayte Pérez-Olmeda, Javier García-Pérez, Jose Alcamí, Jose L. Bueno, Rafael F. Duarte, the ConPlas-19 Study Group
Patients on noninvasive ventilation or high-flow oxygen, invasive mechanical ventilation or ECMO, or who died, shown at 28 days according to subgroup analysis.