Kết quả lâm sàng của liệu pháp plasm, huyết thanh phục hồi với hàm lượng kháng thể trung hòa cao ở bệnh nhân COVID-19 nặng phát triển sớm; một nghiên cứu trường hợp – đối chứng

Springer Science and Business Media LLC - Tập 21 - Trang 1-9 - 2022
Nuttakant Nontawong1, Taweegrit Siripongboonsitti2,3, Kriangkrai Tawinprai2, Mana Boonpratoom4, Nawin Krailassiri4, Chayaporn Boonkhum1, Kamonwan Soonklang5, Yong Poovorawan6, Nithi Mahanonda7
1Department of Medicine, Prachathiput Hospital, Pathum Thani, Thailand
2Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
3Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
4Naungsau Hospital, Pathum Thani, Thailand
5Center of Learning and Research in Celebration of HRH Princess Chulabhorn 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
6Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
7Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand

Tóm tắt

Bệnh coronavirus 2019 (COVID-19) gây ra viêm phổi đe dọa tính mạng. Liệu pháp huyết tương phục hồi (CPT) được kỳ vọng sẽ là phương pháp điều trị COVID-19 hiệu quả cho miễn dịch thụ động. Cần có nồng độ kháng thể trung hòa cao trong CPT để chứng minh lợi ích ở những bệnh nhân COVID-19 nặng phát triển sớm. Nghiên cứu trường hợp – đối chứng này đánh giá hiệu quả truyền máu và các sự kiện bất lợi với huyết tương phục hồi COVID-19 nồng độ cao (≥ 1:320) so với chăm sóc tiêu chuẩn đơn thuần ở bệnh nhân viêm phổi COVID-19 nặng. Trong số 107 bệnh nhân COVID-19 nặng, có 55 bệnh nhân nhận liệu pháp CPT cộng với chăm sóc tiêu chuẩn, và 52 bệnh nhân chỉ nhận chăm sóc tiêu chuẩn. Tỷ lệ tử vong do tất cả nguyên nhân là 15,3% trong nhóm CPT so với 85,4% trong nhóm chăm sóc tiêu chuẩn (p < 0,001). Phân tích đơn biến và đa biến cho thấy tỷ lệ tử vong giảm khi sử dụng CPT (HR 0,14; 95% CI 0,07–0,31; p < 0,001 và HR 0,26; 95% CI 0,08–0,79; p = 0,018, tương ứng). CPT đã dẫn đến giảm cần thiết sử dụng thở máy, thời gian oxy bổ sung, và nhu cầu oxy dòng cao. Các kết quả lâm sàng và hình ảnh học được cải thiện. Huyết tương phục hồi với nồng độ kháng thể trung hòa cao ngay lập tức là an toàn và giảm tỷ lệ tử vong ở những bệnh nhân COVID-19 nặng phát triển sớm. Lợi ích của CPT trong giai đoạn đầu của bệnh là một thách thức và cần phải nghiên cứu bổ sung. Đăng ký thử nghiệm: cơ sở dữ liệu thử nghiệm lâm sàng Thái Lan (TCTR) no. 20220101003.

Từ khóa

#COVID-19 #huyết tương phục hồi #kháng thể trung hòa #viêm phổi #tỷ lệ tử vong

Tài liệu tham khảo

COVID-19 Coronavirus Pandemic: Wordometer; 2021 [Available from: https://www.worldometers.info/. Joyner MJ, Carter RE, Senefeld JW, Klassen SA, Mills JR, Johnson PW, et al. Convalescent plasma antibody levels and the risk of death from Covid-19. N Engl J Med. 2021;384(11):1015–27. Luke TC, Casadevall A, Watowich SJ, Hoffman SL, Beigel JH, Burgess TH. Hark back: passive immunotherapy for influenza and other serious infections. Crit Care Med. 2010;38:e66–73. Casadevall A, Scharff MD. Serum therapy revisited: animal models of infection and development of passive antibody therapy. Antimicrob Agents Chemother. 1994;38(8):1695–702. Luke TC, Kilbane EM, Jackson JL, Hoffman SL. Meta-analysis: convalescent blood products for Spanish influenza pneumonia: a future H5N1 treatment? Ann Intern Med. 2006;145(8):599–609. Hung IF, To KK, Lee C-K, Lee K-L, Chan K, Yan W-W, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis. 2011;52(4):447–56. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial. JAMA. 2020;324(5):460–70. Salazar E, Perez KK, Ashraf M, Chen J, Castillo B, Christensen PA, et al. Treatment of coronavirus disease 2019 (COVID-19) patients with convalescent plasma. Am J Pathol. 2020;190(8):1680–90. Dhasmana DJ. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial. Lancet. 2021. https://doi.org/10.1016/S0140-6736(21)00897-7. Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P. Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial). BMJ. 2020;371: m3939. Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, et al. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med. 2021;384(7):619–29. Joyner MJ, Bruno KA, Klassen SA, Kunze KL, Johnson PW, Lesser ER, et al., editors. Safety update: COVID-19 convalescent plasma in 20,000 hospitalized patients. Mayo Clinic Proceedings 2020 Elsevier. Joyner MJ, Wright RS, Fairweather D, Senefeld JW, Bruno KA, Klassen SA, et al. Early safety indicators of COVID-19 convalescent plasma in 5000 patients. J Clin Investig. 2020. https://doi.org/10.1172/JCI140200. Bloch EM, Shoham S, Casadevall A, Sachais BS, Shaz B, Winters JL, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Investig. 2020;130(6):2757–65. Casadevall A, Scharff MD. Return to the past: the case for antibody-based therapies in infectious diseases. Clin Infect Dis. 1995;21(1):150–61. Joyner MJ, Klassen SA, Senefeld J, Johnson PW, Carter RE, Wiggins CC, et al. Evidence favouring the efficacy of convalescent plasma for COVID-19 therapy. medRxiv. 2020. https://doi.org/10.1101/2020.07.29.20162917. Casadevall A, Pirofski a-L. The convalescent sera option for containing COVID-19. J Clin Investig. 2020;130(4):1545–8. Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, et al. Infectious diseases society of america guidelines on the treatment and management of patients with COVID-19. Clin Infect Dis. 2020. https://doi.org/10.1093/cid/ciaa478. Department of Medical Sciences, Clinical Practice Guideline of Diagnosis, Treatment and Prevention of Coronavirus disease 2019 (COVID-19) for Health care Providers 6 May 2021, Ministry of Public Health. https://ddc.moph.go.th/viralpneumonia/eng/index.php. Accessed 30 May 2021. Joyner MJ, Senefeld JW, Klassen SA, Mills JR, Johnson PW, Theel ES, et al. Effect of convalescent plasma on mortality among hospitalized patients with COVID-19: initial three-month experience. Medrxiv. 2020. https://doi.org/10.1101/2020.08.12.20169359v1. O’Donnell MR, Grinsztejn B, Cummings MJ, Justman JE, Lamb MR, Eckhardt CM, et al. A randomized double-blind controlled trial of convalescent plasma in adults with severe COVID-19. J Clin Invest. 2021. https://doi.org/10.1172/JCI150646. Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, Annane D, et al. Effect of convalescent plasma on organ support-free days in critically Ill patients with COVID-19: a randomized clinical trial. JAMA. 2021;326(17):1690–702. Bégin P, Callum J, Jamula E, Cook R, Heddle NM, Tinmouth A, et al. Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial. Nat Med. 2021;27(11):2012–24. Avendaño-Solá C, Ramos-Martínez A, Muñez-Rubio E, Ruiz-Antorán B, de MolinaMalo R, Torres F, et al. A multicenter randomized open-label clinical trial for convalescent plasma in patients hospitalized with COVID-19 pneumonia. J Clin Invest. 2021. https://doi.org/10.1172/JCI152740. Gharbharan A, Jordans CCE, GeurtsvanKessel C, den Hollander JG, Karim F, Mollema FPN, et al. Effects of potent neutralizing antibodies from convalescent plasma in patients hospitalized for severe SARS-CoV-2 infection. Nat Commun. 2021;12(1):3189. Villa CH. Clinical Memorandum: COVID-19 Convalescent Plasma. US Food & Drug Administration (FDA) 2021:3–11. https://www.fda.gov/media/141480/download. Rasheed AM, Ftak DF, Hashim HA, Maulood MF, Kabah KK, Almusawi YA, et al. The therapeutic effectiveness of Convalescent plasma therapy on treating COVID-19 patients residing in respiratory care units in hospitals in Baghdad, Iraq. medRxiv. 2020;28(3):357. Cheng Y, Wong R, Soo Y, Wong W, Lee C, Ng M, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis. 2005;24(1):44–6. Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The lancet. 2020;395(10236):1569–78. Liu ST, Lin H-M, Baine I, Wajnberg A, Gumprecht JP, Rahman F, et al. Convalescent plasma treatment of severe COVID-19: a propensity score–matched control study. Nat Med. 2020;26(11):1708–13. Martinez-Resendez MF, Castilleja-Leal F, Torres-Quintanilla A, Rojas-Martinez A, Garcia-Rivas G, Ortiz-Lopez R, et al. Initial experience in Mexico with convalescent plasma in COVID-19 patients with severe respiratory failure, a retrospective case series. medRxiv. 2020. https://doi.org/10.1101/2020.07.14.20144469v1. Sullivan DJ, Gebo KA, Shoham S, Bloch EM, Lau B, Shenoy AG, et al. Early outpatient treatment for Covid-19 with convalescent plasma. N Engl J Med. 2022. https://doi.org/10.1056/NEJMoa2119657. Libster R, Pérez Marc G, Wappner D, Coviello S, Bianchi A, Braem V, et al. Early high-titer plasma therapy to prevent severe Covid-19 in older adults. N Engl J Med. 2021;384(7):610–8.
Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 21

1-9

Thông tin tác giả