COVID-19
Conditions
Keywords
COVID-19 convalescent plasma treatment, SARS-CoV-2 infection, Dosing, Safety, Effectiveness
Brief summary
Convalescent plasma has been shown to be safe and effective for treatment of several diseases. Preliminary data indicates that it is safe and effective for treatment of COVID. However, data is limited to small studies and case series on severely ill patients. In a preliminary safety study 10 patients with severe COVID-19, defined as requiring supplementary oxygen, having fever and a duration of illness less than 11 days were treated with 200 ml of CP. CP was given as a slow infusion without obvious adverse events. Eight patients had viremia. One patient rapidly cleared the virus and recovered following CP treatment. CP infusion did not appear to clear viremia in 7/8 patients. Five of these were eventually admitted to ICU. Thus CP did not appear to cause acute toxicity but did not seem to be effective at the dose used. Viremia seemed to be a marker of a high risk of disease progression The proposed study thus aims to treat a high risk population identified by having viremia irrespective of but hopefully before they develop pulmonary injury such that they require supplementary oxygen therapy. Moreover the dose of plasma will be increased incrementally with the aim of clearing viremia as our initial study indicates that continued viremia is driving COVID-19.
Interventions
BIOLOGICALSARS-CoV-2 convalescent plasma
Treatment with convalescent plasma (200ml, up to a maximum of 7 CP infusions). Plasma from consenting individuals who have recovered from SARS-CoV-2 infection.
Sponsors
Danderyd Hospital
Karolinska University Hospital
Karolinska Institutet
Joakim Dillner
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
An open, non-randomised controlled, safety and dose identifying clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or older * Admitted to a study hospital * Active COVID-19 defined as symptoms + SARS CoV-2 identified from upper or lower airway samples * Negative pregnancy test taken before inclusion and use of an acceptable effective method of contraception until treatment discontinuation if the participant is a woman of childbearing potential * Written informed consent after meeting with a study physician and ability and willingness to complete follow up
Exclusion criteria
* No matching plasma donor (Exact matching in both the ABO system is required) * Unavailability of plasma * Significant growth of alternative lower airway pathogen such as Streptococcus pneumoniae or Haemophilus influenzae in sputum * Estimated glomerular filtration rate \<60 (kidney failure stage III or more) * Pregnancy (urinary-hcg) * Breast feeding * History of severe allergic reactions to foods or other substances that the donor may have been exposed to (for example severe peanut allergy) * Inability to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number and proportion of patients with progression to ventilation or sustained requirement of supplementary oxygen therapy | Measured in the first 28 days after inclusion. | Progression to non-invasive or invasive ventilation or a sustained requirement of 15L of supplementary oxygen therapy in patients that are not eligible for intensive care treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dose of plasma needed to clear viremia | 28 days | Measured as doses of convalescent plasma administered (1-7 infusions, 200ml). |
| Clearance of viremia | 6 months. | SARS-CoV-2 RNA detection by PCR in blood or serum. Blood samples for immunological analyses and serology will be taken daily until discharge, on day 28, and at 6 months. |
| Adverse events | The reporting period for AEs starts at inclusion and ends at the final follow-up visit 2 months after inclusion. | Adverse reactions and serious adverse reactions. The safety of the intervention will be assessed with regard to AEs, baseline medical conditions, and findings from the physical examination and laboratory tests. Possible adverse events will be elicited using a modification and Swedish translation (appendix 6) of Common Terminology Criteria for Adverse Events v5.0 and they will be continuously reported to the sponsor. Adverse events related to convalescent plasma therapy shall be followed to assess reversibility. |
| Inflammatory parameters | Until discharged from the hospital, up to 2 months | Time to normalization of inflammatory parameters. Blood samples for inflammatory parameters will be taken daily until normalized or discharged from the hospital. |
| Antibody response to SARS-CoV-2 | 6 months | Characterization of the antibody response to SARS-CoV-2. Blood samples for immunological analyses and serology will be taken daily until discharge, on day 28, and at 6 months. |
| Fever and symptoms | Until discharged from the hospital, up to 2 months | Time to resolution of fever and symptoms. Breathing rate, peripheral oxygen saturation (measured with pulse oximetry after 20 minutes of rest), oxygen use, pulse, blood pressure, body temperature and mental state will be monitored 3 times/day while hospitalized. |
Countries
Sweden
Outcome results
None listed