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[Preprint]. 2020 Dec 4:2020.12.02.20242909.
doi: 10.1101/2020.12.02.20242909.

Treatment of Severe COVID-19 with Convalescent Plasma in the Bronx, NYC

Hyun Ah Yoon  1 , Rachel Bartash  1 , Inessa Gendlina  1 , Johanna Rivera  1   2 , Antonio Nakouzi  1   2 , Robert H Bortz 3rd  2 , Ariel S Wirchnianski  2   3 , Monika Paroder  4 , Karen Fehn  5 , Leana Serrano-Rahman  4 , Rachelle Babb  1   2 , Uzma N Sarwar  1 , Denise Haslwanter  2 , Ethan Laudermilch  2 , Catalina Florez  2   6 , M Eugenia Dieterle  2 , Rohit K Jangra  2 , J Maximilian Fels  2 , Karen Tong  3 , Margarette C Mariano  3 , Olivia Vergnolle  3 , George I Georgiev  3 , Natalia G Herrera  3 , Ryan J Malonis  3 , Jose A Quiroz  3 , Nicholas C Morano  3 , Gregory J Krause  7   8 , Joseph M Sweeney  9 , Kelsie Cowman  1 , Stephanie Allen  10 , Jayabhargav Annam  10 , Ariella Applebaum  10 , Daniel Barboto  10 , Ahmed Khokhar  10 , Brianna J Lally  10 , Audrey Lee  10 , Max Lee  10 , Avinash Malaviya  10 , Reise Sample  10 , Xiuyi A Yang  10 , Yang Li  11 , Rafael Ruiz  12   13 , Raja Thota  12 , Jason Barnhill  6 , Doctor Y Goldstein  4 , Joan Uehlinger  4 , Scott J Garforth  3 , Steven C Almo  3   9 , Jonathan R Lai  3 , Morayma Reyes Gil  4 , Amy S Fox  4 , Kartik Chandran  2 , Tao Wang  11 , Johanna P Daily  1   2 , Liise-Anne Pirofski  1   2
Affiliations

Treatment of Severe COVID-19 with Convalescent Plasma in the Bronx, NYC

Hyun Ah Yoon et al. medRxiv. .

Update in

  • Treatment of severe COVID-19 with convalescent plasma in Bronx, NYC.
    Yoon HA, Bartash R, Gendlina I, Rivera J, Nakouzi A, Bortz RH 3rd, Wirchnianski AS, Paroder M, Fehn K, Serrano-Rahman L, Babb R, Sarwar UN, Haslwanter D, Laudermilch E, Florez C, Dieterle ME, Jangra RK, Fels JM, Tong K, Mariano MC, Vergnolle O, Georgiev GI, Herrera NG, Malonis RJ, Quiroz JA, Morano NC, Krause GJ, Sweeney JM, Cowman K, Allen S, Annam J, Applebaum A, Barboto D, Khokhar A, Lally BJ, Lee A, Lee M, Malaviya A, Sample R, Yang XA, Li Y, Ruiz R, Thota R, Barnhill J, Goldstein DY, Uehlinger J, Garforth SJ, Almo SC, Lai JR, Gil MR, Fox AS, Chandran K, Wang T, Daily JP, Pirofski LA. Yoon HA, et al. JCI Insight. 2021 Feb 22;6(4):e142270. doi: 10.1172/jci.insight.142270. JCI Insight. 2021. PMID: 33476300 Free PMC article.

Abstract

Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as treatment for Coronavirus Disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200mL of CCP with a Spike protein IgG titer ≥1:2,430 (median 1:47,385) within 72 hours of admission to propensity score-matched controls cared for at a medical center in the Bronx, between April 13 to May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroids, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared to matched controls, CCP recipients <65 years had 4-fold lower mortality and 4-fold lower deterioration in oxygenation or mortality at day 28. For CCP recipients, pre-transfusion Spike protein IgG, IgM and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients <65 years, but data from controlled trials is needed to validate this finding and establish the effect of ageing on CCP efficacy.

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Conflict of interest statement

Conflicts of Interest statement KC is a member of the Scientific Advisory Board of Integrum Scientific, LLC. In addition, KC has a SARS-CoV-2 spike neutralization assay patent pending, and a SARS-CoV-2 spike antibody assay patent pending. JL reports grants from Adimab LLC, grants from Integrated BioTherapeutics, grants from Mapp Biopharmaceutical, personal fees from Johnson & Johnson, personal fees from Celdara Medical. In addition, JL has a COVID-19 antibody diagnostic patent pending. Other authors have declared that no conflict of interest exists.

Figures

Figure 1.
Figure 1.
Enrollment of Study Patients and Distribution of Study Cohorts. Study baseline was defined as time of CCP transfusion for CCP recipients and admission day 2 for non CCP recipients. COVID-19, coronavirus disease 2019; CCP, COVID-19 convalescent plasma; EAP, expanded access protocol; LAR, legally authorized representative; MMC, Montefiore Medical Center; NC, nasal cannula.
Figure 2.
Figure 2.
Kaplan–Meier Plot of the Probability of Survival from time of transfusion to day 28 in CCP recipients (n = 73) vs matched controls (n = 73). A. All age groups. B. Age < 65 years. C. Age ≥ 65 years.
Figure 3.
Figure 3.
Day 28 outcomes for CCP recipients (n = 73) vs matched controls (n = 73) presented by odds ratio and 95% confidence intervals. A. All age groups (n = 73 cases vs 73 controls). B. Age < 65 years (n = 34 vs 34). C. Age ≥ 65 years (n = 39 vs 39). CCP, COVID-19 convalescent plasma; CI, confidence interval; OR, odds ratio.
Figure 4.
Figure 4.
SARS-CoV-2 spike protein IgG titers determined by ELISA at baseline (Day −1 or D-1) and 1, 3 and 7 day after transfusion (D1, D3 and D7) in CCP recipients. (A) Age < 65 years. (B) Age ≥ 65 years. (C) Alive at day 28. (D) Died by day 28. (E) Not intubated on day of transfusion. (F) Intubated on day of transfusion. Correlation between baseline spike protein IgG titer and (G) D-dimer and (H) cycle threshold (Ct) value from initial nasopharyngeal SARS-CoV-2 RT-PCR in CCP recipients. The median titers and interquartile ranges are shown on the y-axis for each time point shown on the x-axis (A-F). X-axis shows days relative to convalescent plasma transfusion (A-F). Open circles show patients who died by day 28 (G, H). r: Spearman’s correlation coefficient. Ct value, cycle threshold value.
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