Convalescent plasma in hospitalised patients with COVID-19

Zoe McQuilten¹, Matthew V N O'Sullivan^{2

3

4}, Damien Purcell⁵, Peta Edler⁵, Niamh Meagher⁵, Kylie Alcorn⁶, Asha Bowen^{7

8}, James Daly⁹, Hong Foo¹⁰, Susan Goulding⁵, Iain Gosbell⁹, Naomi Hammond^{11

12}, Thomas Hills^{13

14}, Veronica Hoad⁹, Vivekanand Jha^{15

16

17}, Lyn Li Lim¹⁸, Grace McPhee⁵, James Molton¹⁹, Susan Morpeth²⁰, Vi Nguyen⁵, David Paterson²¹, Megan Rees^{22

23}, Jason Roberts^{24

25

26

27

28}, Benjamin A Rogers²⁹, Adam Stewart^{30

31}, Joe Sasadeusz^{5

32}, Thomas Snelling³³, Balasubramanian Venkatesh^{6

14

34

35}, Erica Wood¹, Joshua S Davis³⁴, Steven Y C Tong^{5

32}, David J Price^{5

36}, Justin T Denholm^{5

32}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
² Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia.
⁵ Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁶ Infectious Diseases Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
⁷ Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute of Australia, University of Western Australia, Perth, Western Australia, Australia.
⁸ Perth Children's Hospital, Perth, Western Australia, Australia.
⁹ Australian Red Cross Lifeblood, Melbourne, Victoria, Australia.
¹⁰ Department of Microbiology and Infectious Diseases, NSW Health Pathology - Liverpool, Sydney, New South Wales, Australia.
¹¹ Critical Care Program, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
¹² Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹³ Medical Research Institute of New Zealand, Wellington Regional Hospital, Wellington, New Zealand.
¹⁴ Department of Infectious Diseases, Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand.
¹⁵ George Institute for Global Health, UNSW, New Delhi, India.
¹⁶ School of Public Health, Imperial College, London, UK.
¹⁷ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹⁸ Monash University, Melbourne, Victoria, Australia.
¹⁹ Department of Infectious Diseases, Western Health, Melbourne, Victoria, Australia.
²⁰ Department of Infectious Diseases, Middlemore Hospital, Counties Manukau, Te Whatu Ora Health New Zealand, Auckland, New Zealand.
²¹ ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
²² Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
²³ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
²⁴ University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
²⁵ Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia.
²⁶ Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²⁷ Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²⁸ Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
²⁹ Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
³⁰ Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
³¹ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia.
³² Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
³³ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³⁴ Infection Research Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
³⁵ University of New South Wales, Sydney, New South Wales, Australia.
³⁶ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 41273107
DOI: 10.1111/imj.70253

Convalescent plasma in hospitalised patients with COVID-19

Zoe McQuilten et al. Intern Med J. 2025.

. 2025 Nov 22.

doi: 10.1111/imj.70253. Online ahead of print.

Authors

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
² Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia.
⁵ Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁶ Infectious Diseases Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
⁷ Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute of Australia, University of Western Australia, Perth, Western Australia, Australia.
⁸ Perth Children's Hospital, Perth, Western Australia, Australia.
⁹ Australian Red Cross Lifeblood, Melbourne, Victoria, Australia.
¹⁰ Department of Microbiology and Infectious Diseases, NSW Health Pathology - Liverpool, Sydney, New South Wales, Australia.
¹¹ Critical Care Program, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
¹² Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹³ Medical Research Institute of New Zealand, Wellington Regional Hospital, Wellington, New Zealand.
¹⁴ Department of Infectious Diseases, Te Toka Tumai Auckland, Auckland City Hospital, Auckland, New Zealand.
¹⁵ George Institute for Global Health, UNSW, New Delhi, India.
¹⁶ School of Public Health, Imperial College, London, UK.
¹⁷ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹⁸ Monash University, Melbourne, Victoria, Australia.
¹⁹ Department of Infectious Diseases, Western Health, Melbourne, Victoria, Australia.
²⁰ Department of Infectious Diseases, Middlemore Hospital, Counties Manukau, Te Whatu Ora Health New Zealand, Auckland, New Zealand.
²¹ ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
²² Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
²³ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
²⁴ University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
²⁵ Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia.
²⁶ Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²⁷ Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
²⁸ Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
²⁹ Department of Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
³⁰ Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
³¹ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia.
³² Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
³³ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³⁴ Infection Research Program, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
³⁵ University of New South Wales, Sydney, New South Wales, Australia.
³⁶ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 41273107
DOI: 10.1111/imj.70253

Abstract

Background: Convalscent plasma (CP) was identified as a potential therapy for COVID-19 available early in the pandemic.

Aims: To evaluate CP for the treatment of hospitalised adults with COVID-19 within the Australasian COVID-19 Trial (ASCOT).

Methods: ASCOT is an investigator-initiated, international, open-label, randomised clinical trial. Adult patients hospitalised with confirmed SARS-CoV-2 within 12 days of symptom onset and not receiving intensive respiratory or vasopressor/inotropic support were randomised to two units of CP or standard care. The primary outcome was the proportion of participants who died or required intensive respiratory support (invasive or non-invasive ventilation) or vasopressors/inotropic support in the 28 days after randomisation. The trial steering committee decided to discontinue the study in January 2021 in response to external evidence suggesting the futility of CP.

Results: Between May and November 2020, 33 participants were enrolled from eight sites across Australia and New Zealand. At baseline, nine (53%) in standard care and seven (47%) in CP arms required supplemental oxygen, three participants (all in the CP arm) required non-invasive ventilation or high-flow oxygen and over half were taking dexamethasone. The primary outcome was met by 23.5% (4/17) of standard care and 7% (1/15) of CP participants. One serious adverse event was reported in the CP arm, which was deemed not treatment-related.

Conclusion: Fewer participants allocated to CP died or required new intensive respiratory or vasopressors/inotropic support in the 28 days after randomisation compared to standard care. However, our trial was stopped early in response to external evidence, and our sample size was small, limiting any definitive conclusions regarding the efficacy or safety of CP.

Keywords: COVID‐19; convalescent plasma; hospitalised patients; randomised controlled trial.

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References

1. Mair‐Jenkins J, Saavedra‐Campos M, Baillie JK, Cleary P, Khaw FM, Lim WS et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta‐analysis. J Infect Dis 2015; 211: 80–90.
1. Franchini M, Glingani C, Liumbruno GM. Potential mechanisms of action of convalescent plasma in COVID‐19. Diagnosis 2021; 8: 413–420.
1. Joyner MJ, Wright RS, Fairweather D, Senefeld JW, Bruno KA, Klassen SA et al. Early safety indicators of COVID‐19 convalescent plasma in 5,000 patients. J Clin Invest 2020; 130: 4791–4797.
1. Group RC. Convalescent plasma in patients admitted to hospital with COVID‐19 (RECOVERY): a randomised controlled, open‐label, platform trial. Lancet 2021; 397: 2049–2059.
1. Denholm JT, Venkatesh B, Davis J, Bowen AC, Hammond NE, Jha V et al. ASCOT ADAPT study of COVID‐19 therapeutics in hospitalised patients: an international multicentre adaptive platform trial. Trials 2022; 23: 1014.

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GNT2002132/Australian Government Medical Research Future Fund

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Convalescent plasma in hospitalised patients with COVID-19

Affiliations

Convalescent plasma in hospitalised patients with COVID-19

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous