Mortality rates in matched cohort, pseudo-randomised and randomised trials of convalescent plasma given to COVID-19 patients

Amar Ahmad, Marwa Salsabil,Tim Oliver

medrxiv(2020)

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摘要
Introduction For more than 80 years convalescent or immune sera has been used in severe life threatening infections. Since March of this year a rapidly increasing number of publications have reported series of Convalescent plasma (CP) investigations in severely ill COVID-19 patients. Objective a brief CP scoping review focusing on early mortality Methods We searched available data bases. Three randomised trials, two pseudo-randomised observations and twelve matched cohort studies were identified. Random-effects meta-analyses were performed on extracted data Results A total of 2,378 CP treated and 5188 “controls” in 17 studies. Individually only two studies were significant for reduction of deaths to 30 days, but all showed a similar percentage reduction. When pooled, meta-analysis was undertaken. It showed that the overall reduction of death was significant for all series RR 0.710 (p=0.00001), all matched cohort series RR = 0.610 (p-value = 0.001) and the two pseudo-randomised series RR 0.747 (p=0.005) but not the three technically inadequate randomised trials, RR 0.825 (p=0.397). In two of these randomised trials, there was faster clearance of Viral DNA at 72 hours after CP than placebo Conclusion It is hoped the significance of this less than perfect data will increase interest in completing the delayed randomised trials as the results suggest they could be better than currently licenced drugs. Given increasing published evidence of increased risk of both diagnosis and death from COVID-19 in patients with severe Vitamin-D deficiency, future studies should also study influence of Vitamin-D status of donor and recipient on outcome. View this table: ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There was no funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: NA All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes contact asa12@nyu.edu
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convalescent plasma,mortality rates,cohort,pseudo-randomised
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