JAMA: The first large sample RCT study poured cold water, and the plasma of COVID-19 recoverers was only effective in critical and non-critical patients

As of June 10, 2020, the new coronavirus (SARS-CoV-2)-caused disease (
COVID-19) has caused more than 7.3 million people worldwideand 410,000 people die;medical scientists have been working to find a cure for COVID-19; there are antibodies to COVID-19 in the plasma of the recovered, and previous reports have shown that the plasma of the recovered person is effective, raising expectations for the treatment, a randomized controlled study poured cold water on the efficacy of COVID-19 in plasma therapy in rehabilitation;In a scathing article published in the journal JAMA, the Institute of Blood Transfusion of the Chinese Academy of Medical Sciences found that plasma therapy in rehabilitative patients was generally ineffective, but could improve the clinical symptoms of patients with severe illness, rather than critical conditionsThe study was the first to study a randomized controlled open label study with a large sample sizethe study entitled "Effect of Convales cent Plasma Therapy on Time to Clinical Clinical With Patients With and Life-bully COVID-19A - Randomized Clinical Trial" on June 3, 2020Research objects and methodssubjects and treatments:study enrolled 103 patients with severe/critical conditions, 52 patients with the standard treatment of plasma and plasma, and 51 patients with standard treatment as a control (Figure 1)(Figure 1Patients in the group and treatment)the study endpoint: study mainly evaluated the clinical performance improvement after 28 days of treatment (6 component table increased by 2 points), fatality rate, viral nucleic acid transvulsion rate, etc (Table 1 Part of the population characteristics and clinical manifestations of the patients) (table 2 Clinical status of patients at the time of plasma treatment) the main results 1 Compared with the two groups, the rehabilitation patient seplasma treatment is not effective as shown in Table 2, when the comparative analysis of all patients, found that in the clinical improvement time, 28 days of patient improvement rate, fatality rate and discharge rate, etc found that the clinical improvement time of the plasma therapy group in the rehabilitation group was 51.9%:43.1%, and there was no statistical difference between the two groups (HR 1.4, 95% 0.79-1.4, p - 0.26) the patient's plasma rate was not improved for 28 days there was no statistical difference in the death rate of the and control group in the the patient's plasma treatment group and the control group (15.7%:24%, p -0.3), and there was no statistical difference in the 28-day discharge rate of patients (51%:36%, p -0.13) (table 3 main and secondary clinical outcome indicators) 2 The plasma therapy of the rehabilitators can improve the improvement time of patients with severe illness
as shown in Table 3, after plasma therapy in the rehabilitation, the clinical improvement time of severe patients increased by an average of 4.94 days, the difference was statistically significant (HR 2.15, 95% 1.07-4.32, p 0.03) to 28 days, the proportion of patients in the rehabilitation plasma therapy group improved by 91.3%, the control group was 68.2%, and p was 0.07 3 The plasma therapy of the recovered patients failed to improve the improvement time of critically ill patients as shown in Table 3/2, after plasma therapy in the rehabilitation patients, the clinical improvement time and the improvement rate of patients in critical lysacpatients were not improved (Figure 2, comparison of clinical improvement time) 4 The plasma therapy of the recovered person can provide patients with viral nucleic acid to negative the patient who received the rehabilitation of the plasma patients after 72 hours of significantly increased viral nucleic acid transvulsion rate (87.2% : 37.5%, p 0.01) Hanson Interpretation : 1, the researchers found that 1) compared all patients and found that the plasma therapy of the recovered patients showed no improved effect in terms of clinical improvement time, patient improvement rate at 28 days, death rate and discharge rate; After plasma therapy, the clinical improvement time of patients with severe illness increased by an average of 4.94 days, the difference was statistically significant, 3) critically ill patients failed to benefit from the plasma therapy of the recovered patients, and 4) the rate of viral nucleic acid transvulsion was significantly increased after 72 hours in the patients who received the rehabilitation this result suggests that the plasma of the recovered person has antiviral effect, which can improve the clinical performance of patients with severe illness, rather than critical 2, the problem in the design of this study the recovery plasma contains antiviral antibodies, and the role of antibodies can directly close the virus epitope to suppress the virus, but also through the action of antibody Fc to remove infected cells and COVID-19 patients tend to have peak viral loads about 1 week after onset, so using plasma therapy before the peak viral load can help patients to relieve infection, remove infected cells, and further avoid sexual lung and other organ damage and carefulanalysi analysis, it can be found that in this study of the rehabilitation of the plasma treatment group 93.9% of the randomized group treatment 14 days after the onset of the disease This is an issue that needs to be considered in the analysis of the results of this study We look forward to seeing the results of the results of the early treatment of the disease