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

Convalescent Plasma Study Group; Mair-Jenkins, John; Saavedra-Campos, Maria; Baillie, J. Kenneth; Cleary, Paul; Khaw, Fu-Meng; Lim, Wei Shen; Makki, Sophia; Rooney, Kevin D; Beck, Charles R.; Nguyen-Van-Tam, Jonathan S.

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.

Citation

Convalescent Plasma Study Group, Mair-Jenkins, J., Saavedra-Campos, M., Baillie, J. K., Cleary, P., Khaw, F., …Nguyen-Van-Tam, J. S. (2015). 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. Journal of Infectious Diseases, 211(1), 80-90. https://doi.org/10.1093/infdis/jiu396

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2014
• Online Publication Date: Jul 16, 2014
• Publication Date: Jan 1, 2015
• Deposit Date: Oct 19, 2016
• Publicly Available Date: Oct 19, 2016
• Journal: Journal of Infectious Diseases
• Print ISSN: 0022-1899
• Electronic ISSN: 1537-6613
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 211
• Issue: 1
• Pages: 80-90
• DOI: https://doi.org/10.1093/infdis/jiu396
• Keywords: MERS coronavirus; convalescent plasma; severe acute respiratory infection; systematic review; meta-analysis
• Public URL: https://nottingham-repository.worktribe.com/output/732362
• Publisher URL: http://jid.oxfordjournals.org/content/211/1/80
• Related Public URLs: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264590/