WHO Says No To Convalescent Plasma for COVID-19

Pavankumar Kamat

December 07, 2021

The World Health Organization (WHO) Guideline Development Group (GDG) in its living 'WHO Guideline on Drugs for COVID-19' is not recommend the use of convalescent plasma for patients with COVID-19.

In the guideline's most recent update, published in  The BMJ , the GDG strongly recommends against the use of the convalescent plasma in patients with non-severe illness. Additionally, it also recommends against the routine use of convalescent plasma in patients with severe and critical illness, except in clinical trial settings.

Evidence for the recommendations comes from 16 RCTs, involving 16,236 patients with non-severe, severe, and critical COVID-19.

For non-severe cases, plasma had no effect on mortality risk (OR, 0.83; 95% CI 0.43 to 1.46) and probably no impact on risk of mechanical ventilation (OR, 0.71; 95% CI 0.18 to 1.77). No data were available on the risk of hospitalisation with convalescent plasma.

The GDG said that "plasma administration, especially for patients with non-severe illness where there is a low baseline risk of mortality and other important clinical outcomes, is not justified."

For severe cases, plasma possibly had little or no effect on mortality risk (OR 0.92, 95% CI 0.70 to 1.12). Additionally, plasma had no significant impact on mechanical ventilation, time to symptom improvement, length of hospital stay, or ventilator-free days.

The GDG also acknowledges that "although convalescent plasma should not be used in any severity subgroups as part of routine care, there was sufficient uncertainty in patients with severe and critical illness to warrant continuation of RCTs."

The living guidelines are developed by the WHO in collaboration with the MAGIC Evidence Ecosystem Foundation. These guidelines are regularly updated with new recommendations and revisions to previous recommendations, based on emerging evidence from randomised controlled trials (RCTs).

The guideline did not receive any specific funding. MAGIC provided pro-bono contributions and support to the WHO in the context of the COVID-19 pandemic.

BMJ. 2020;370:m3379. Full text.



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