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 - PubMed (original) (raw)
Review
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
John Mair-Jenkins et al. J Infect Dis. 2015.
Abstract
Background: Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence.
Methods: Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken.
Results: We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14-.45; I(2) = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified.
Conclusions: Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection.
Keywords: MERS coronavirus; convalescent plasma; meta-analysis; severe acute respiratory infection; systematic review.
© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
Figures
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. aRecords were rejected for the following reasons: not population of interest, 12 records (1 in French, 1 in German, 1 in Italian, and 1 in Korean); no intervention of interest, 15 (1 in German); not suitable comparator, 1; nonhuman study, 1; and no outcome of interest, 7.
Figure 2.
Summary of outcome level risk of bias assessments in eligible observational studies, using the Newcastle Ottawa tool (excluding prospective cohort studies; 44 outcomes from 25 studies).
Figure 3.
Forest plot of pooled odds ratios (ORs) of mortality following treatment with convalescent plasma or convalescent serum (n = 8 studies). Weights are from random-effects analysis. Abbreviation: CI, confidence interval.
Figure 4.
Forest plot of pooled odds ratios (ORs) of mortality following treatment with convalescent plasma or convalescent serum, excluding studies with <5 patients (n = 5 studies). Weights are from random-effects analysis. Abbreviation: CI, confidence interval.
Comment in
- Convalescent plasma as a potential therapy for COVID-19.
Chen L, Xiong J, Bao L, Shi Y. Chen L, et al. Lancet Infect Dis. 2020 Apr;20(4):398-400. doi: 10.1016/S1473-3099(20)30141-9. Epub 2020 Feb 27. Lancet Infect Dis. 2020. PMID: 32113510 Free PMC article. No abstract available.
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