Clinical Efficacy of Early Administration of Convalescent Plasma among COVID-19 Cases in Egypt

Noha Asem; Hossam Hosny Massoud; Ihab Serag; Mohamed Hassany; Gehan ElAssal; Akram Abdelbary; Marwa Mohsen; Amin Abdel Baki; Samy Zaky; Wagdy Amin; Ehab Kamal; Hamdy Ibrahem; Ahmed Said Abdel Mohsen; Mohamed Ibrahem; Mohamed Ahmed Ali; Nancy Elgendy; Mohamed Elbadry; Salwa Hassan; Naguib Naguib Nassif Shenouda; Mohamed Abdelhamed Fathy; Hala Zaid

doi:10.3889/oamjms.2022.8057

Authors

Noha Asem Department of Public Health and Community Medicine, Cairo University, Cairo, Egypt; Ministry of Health and Population, Cairo, Egypt
Hossam Hosny Massoud Department of Pulmonology, Cairo University, Cairo, Egypt
Ihab Serag Ministry of Health and Population, Cairo, Egypt
Mohamed Hassany Department of Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Gehan ElAssal Department of Pulmonology, Ain Shams University, Cairo, Egypt
Akram Abdelbary Department of Critical Care Medicine, Cairo University, Cairo, Egypt
Marwa Mohsen Ministry of Health and Population, Cairo, Egypt
Amin Abdel Baki Department of Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Samy Zaky Department of Hepatogastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Wagdy Amin Ministry of Health and Population, Cairo, Egypt
Ehab Kamal Ministry of Health and Population, Cairo, Egypt; Department of Tropical Medicine, Medical Division, National Research Center, Cairo, Egypt
Hamdy Ibrahem Ministry of Health and Population, Cairo, Egypt
Ahmed Said Abdel Mohsen Department of Critical Care Medicine, Cairo University, Cairo, Egypt
Mohamed Ibrahem Department of Clinical Biochemistry, Faculty of medicine, Cairo University, Cairo, Egypt
Mohamed Ahmed Ali Centre of Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
Nancy Elgendy Ministry of Health and Population, Cairo, Egypt; Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
Mohamed Elbadry Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
Salwa Hassan Ministry of Health and Population, Cairo, Egypt
Naguib Naguib Nassif Shenouda Ministry of Health and Population, Cairo, Egypt
Mohamed Abdelhamed Fathy Ministry of Health and Population, Cairo, Egypt
Hala Zaid Ministry of Health and Population, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.8057

Keywords:

COVID-19 pandemic, Convalescent plasma, SARS-CoV-2

Abstract

BACKGROUND: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicenter; Wuhan was first reported in December 2019. Egypt reported its first COVID-19 case on February 14, 2020. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with convalescent plasma transfusion (CPT) are under investigation and data from CPTs have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration suggesting that it may provide a clinical effect in the treatment of SARS-COV-2.

IMPORTANCE: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection.

METHODS: Designs: An interventional, single-arm, and non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. Settings: This was a multi-center study conducted in three hospitals in Egypt. Participants: A total of 94 COVID-19 laboratory-confirmed patients using quantitative real-time polymerase chain reaction were enrolled in the study. Intervention: All patients were administered with two plasma units (each unit is 200 cc). The volume of donated plasma was 800 cc. Main Outcome and measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within 7 days.

RESULTS: A total of 94 patients were enrolled who received CPT either within 7 days or after 7 days of hospitalization. 82 were severely ill and 12 were critically ill. The average age remained 58 years (±standard deviation 15.1 years). Male were 69% and 49% patients got cured while 51% died with case fatality rate 51%. Seventy-five percent deaths were above 45 years of age. The symptoms were dyspnea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained diabetes mellitus (21%) and asthma (14%). Among 40–60 years hypertension (56%), diabetes mellitus (39%) and among >60 years age group hypertension (57%), and chronic heart disease (24%) were reported. CPT within 7 days remained significant as compared with the CPT after 7 days with the number of days to cure (p=0.007) and ICU stay (p = 0.008) among severely ill cured cases.

CONCLUSIONS: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within 7 days with 65% cure rate.

TRIAL REGISTRATION: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020.

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