Convalescent plasma effective for COVID-19 in patients with primary antibody deficiency
Convalescent plasma appeared safe and effective for the treatment of COVID-19 among patients with primary antibody deficiency, according to a study published in Journal of Clinical Immunology.
This benefit occurred even when patients with long-term symptoms received convalescent plasma therapy months after initial COVID-19 diagnosis, researchers found.
Patients with antibody deficiencies have poor humoral response, making convalescent plasma an obvious option for COVID-19 treatment, author Julia Lang-Meli, MD, of the department of medicine II at University Hospital Freiburg in Germany, and colleagues wrote.
The researchers examined 16 patients (male, n = 9; age, 11-71 years) with primary antibody deficiency treated for COVID-19 with convalescent plasma in four medical centers by asking those physicians to retrospectively complete questionnaires about those patients and their care.
Ten of these patients were diagnosed with common variable immunodeficiency, four with X-linked agammaglobulinemia, one with immunodeficiency due to Kabuki syndrome and one with Hyper-IgM syndrome of unknown origin.
The most common COVID-19 symptoms among these patients included fever (n = 14), cough (n = 11) and dyspnea (n = 10). One patient was classified with mild disease, nine with moderate disease and six with severe COVID-19. None had critical symptoms such as acute respiratory distress syndrome or sepsis.
Eight patients received convalescent plasma within 2 weeks of symptomatic onset of COVID-19 due to high risk for disease progression. The other eight patients received treatment between 17 and 132 days after onset.
Seven patients received monotherapy with convalescent plasma, three additionally received remdesivir (Veklury, Gilead), one additionally received dexamethasone, and five additionally received both remdesivir and dexamethasone.
All the patients saw improvements in clinical symptoms following therapy. Five of them experienced clinical response within 7 days of treatment, three of whom received treatment because they showed signs of long-term SARS-Cov-2 infection. Also, 15 of the patients were asymptomatic at last follow-up.
There were no side effects with treatment, except for one patient who experienced a short febrile period. The researchers did not observe any clinical signs of antibody-dependent enhancement or enhanced respiratory disease after treatment.
The researchers further noted that patients with persistent SARS-CoV-2 infection may enable viral evolution and represent a reservoir for emerging variants. But only one patient showed an increase in viral load, which has been associated with emergence of possible antibody escape mutations in the SARS-CoV-2 genome after treatment.
Overall, the researchers suggested that these patients may still require monitoring for viral-escape variants. They also wrote that regular follow-up with SARS-CoV-2 polymerase chain reaction is advisable for these patients.
The researchers concluded that convalescent plasma therapy is sufficiently safe and effective for patients with primary antibody deficiency due to severe COVID-19 or existing risk factors, even when disease has persisted for more than 2 weeks.