Compassionate use of convalescent plasma for treatment of moderate and severe pneumonia in COVID-19 patients and association with IgG antibody levels in donated plasma

Published on
Journal: EClinicalMedicine
[저자] Yasmin Maor, Daniel Cohen, Nir Paran, Tomer Israely, Vered Ezra, Ofra Axelrod, Eilat Shinar, Marina Izak, Galia Rahav, Naomi Rahimi-Levene, Baruch M Bazofin, Ram Gelman, Dror Dicker, Tal Brosh-Nissimov, Orli Megged, David Dahan, Avi Benov, Alona Paz, Jacob Chen
[Category] 치료법,
[DOI] 10.1016/j.eclinm.2020.100525    
[Article Type] Research article
[Source] Sciencedirect

Abstract
Background
We assessed outcome of patients with moderate and severe COVID-19 following treatment with convalescent plasma (CP) and the association with IgG levels in transfused CP.
Methods
A prospective cohort study. Primary outcome was improvement at day 14 defined as alive, not on mechanical ventilation, and moderate, mild, or recovered from COVID-19. Antibody levels in CP units were unknown at the time of treatment. IgG against the spike protein S1 was subsequently measured by ELISA. Neutralizing antibodies titers were determined in a subset. Outcome was assessed in relation to the mean antibody level transfused to the patients (≤4.0 versus >4.0).
Findings
Of 49 patients, 11 (22.4%) had moderate, 38 (77.6%) had severe disease, 28 were ventilated. At day 14, 24 (49.0%) patients improved, 9 (18.4%) died, and 13 (26.5%) were ventilated. In 14/98 (14.3%) CP units IgG was < 1.1 (cutoff calibration) and in 60 (61.2%) ≤4.0. IgG level and neutralizing antibody titer were correlated (0.85 p < 0.001). In patients receiving ≤4.0 antibody levels, 11/30 improved (36.7%) versus 13/19 (68.4%) in patients receiving >4.0 odds ratio (OR) 0.267 [95% confidence interval (CI) 0.079–0.905], P = 0.030. In patients diagnosed >10 days prior to treatment, 4/14 (22.4%) improved in the ≤4.0 antibody group, versus 6/7 (85.7%) in the >4.0 antibody group, OR 0.048 (95% CI, 0.004–0.520), P = 0.007. No serious adverse events were reported.
Interpretation
Treatment with CP with higher levels of IgG against S1 may benefit patients with moderate and severe COVID-19. IgG against S1 level in CP predicts neutralization antibodies titers.

All Keywords
【저자키워드】 convalescent plasma, Compassionate treatment, Moderate and Severe Covid19, 【초록키워드】 COVID-19, Treatment, IgG, severe COVID-19, antibody, outcome, prospective cohort study, ELISA, Patient, Mild, moderate, patients, predict, Neutralization antibody, antibody level, Neutralizing antibody titer, association, Odds ratio, severe disease, confidence interval, Serious Adverse Event, Ventilated, 95% CI, Cutoff, finding, benefit, defined, died, reported, the patient, diagnosed, receiving, the spike protein, correlated, subset, the mean, IgG level, on mechanical ventilation, patients with moderate, transfused, 【제목키워드】 Treatment, IgG antibody, plasma, severe pneumonia, moderate, association, COVID-19 patient,