tetano
Editor, Senior Moderator
mBio
. 2024 Apr 11:e0040024.
doi: 10.1128/mbio.00400-24. Online ahead of print. Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19
Juan G Ripoll[SUP] #[/SUP][SUP] 1 [/SUP], Sidna M Tulledge-Scheitel[SUP] #[/SUP][SUP] 2 [/SUP], Anthony A Stephenson[SUP] 1 [/SUP], Shane Ford[SUP] 1 [/SUP], Marsha L Pike[SUP] 3 [/SUP], Ellen K Gorman[SUP] 1 [/SUP], Sara N Hanson[SUP] 4 [/SUP], Justin E Juskewitch[SUP] 5 [/SUP], Alex J Miller[SUP] 1 [/SUP], Solomiia Zaremba[SUP] 1 [/SUP], Erik A Ovrom[SUP] 1 [/SUP], Raymund R Razonable[SUP] 6 [/SUP], Ravindra Ganesh[SUP] 7 [/SUP], Ryan T Hurt[SUP] 7 [/SUP], Erin N Fischer[SUP] 3 [/SUP], Amber N Derr[SUP] 8 [/SUP], Michele R Eberle[SUP] 9 [/SUP], Jennifer J Larsen[SUP] 8 [/SUP], Christina M Carney[SUP] 10 [/SUP], Elitza S Theel[SUP] 5 [/SUP], Sameer A Parikh[SUP] 11 [/SUP], Neil E Kay[SUP] 11 12 [/SUP], Michael J Joyner[SUP] #[/SUP][SUP] 1 13 [/SUP], Jonathon W Senefeld[SUP] #[/SUP][SUP] 1 13 14 [/SUP]
Affiliations
Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma"). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.
Keywords: SARS-CoV-2; antibody therapy; immunocompromised hosts.
. 2024 Apr 11:e0040024.
doi: 10.1128/mbio.00400-24. Online ahead of print. Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19
Juan G Ripoll[SUP] #[/SUP][SUP] 1 [/SUP], Sidna M Tulledge-Scheitel[SUP] #[/SUP][SUP] 2 [/SUP], Anthony A Stephenson[SUP] 1 [/SUP], Shane Ford[SUP] 1 [/SUP], Marsha L Pike[SUP] 3 [/SUP], Ellen K Gorman[SUP] 1 [/SUP], Sara N Hanson[SUP] 4 [/SUP], Justin E Juskewitch[SUP] 5 [/SUP], Alex J Miller[SUP] 1 [/SUP], Solomiia Zaremba[SUP] 1 [/SUP], Erik A Ovrom[SUP] 1 [/SUP], Raymund R Razonable[SUP] 6 [/SUP], Ravindra Ganesh[SUP] 7 [/SUP], Ryan T Hurt[SUP] 7 [/SUP], Erin N Fischer[SUP] 3 [/SUP], Amber N Derr[SUP] 8 [/SUP], Michele R Eberle[SUP] 9 [/SUP], Jennifer J Larsen[SUP] 8 [/SUP], Christina M Carney[SUP] 10 [/SUP], Elitza S Theel[SUP] 5 [/SUP], Sameer A Parikh[SUP] 11 [/SUP], Neil E Kay[SUP] 11 12 [/SUP], Michael J Joyner[SUP] #[/SUP][SUP] 1 13 [/SUP], Jonathon W Senefeld[SUP] #[/SUP][SUP] 1 13 14 [/SUP]
Affiliations
- PMID: 38602414
- DOI: 10.1128/mbio.00400-24
Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma"). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.
Keywords: SARS-CoV-2; antibody therapy; immunocompromised hosts.