More hospitals participate in plasma transfusion trial to treat COVID-19 with antibodies

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TORONTO –
The first two COVID-19 patients in Canada to receive antibody-rich plasma transfusions show signs of improvement as experimental treatment extends to trials at more than a dozen sites in Ontario and Quebec.

A senior media adviser at CHU Sainte-Justine Hospital in Montreal says the outlook is “favorable” for a patient who was the first to receive a transfusion on May 15, noting that she was released from intensive care.

Meanwhile, a 78-year-old man who received the second transfusion on May 22 at the Toronto General Hospital of the University Health Network is expected to recover fully, says his doctor, Dr. David Hwang.

The patients are part of a randomized controlled trial that tests whether a plasma transfusion from recovered COVID-19 patients can reduce deaths and speed recovery.

The hope is that an influx of antibodies from another person will help an infected patient fight COVID-19 until their body can develop their own anti-virus antibodies.

As of Wednesday, at least five patients had received transfusions, and others joined the trial daily. The researchers hope to study 1,200 participants in about 60 medical centers, 800 of whom will receive transfusions while 400 will be part of a control group that will not receive any transfusions.

A senior CONCOR-1 scientist, Dr. Jeannie Callum of the Sunnybrook Health Sciences Center in Toronto, said the trial will be expanded to at least 20 hospitals by the weekend, most in Ontario but whose a handful in Quebec, and three in New York.

Callum, director of use for the department of laboratory medicine and molecular diagnostics, says the researchers are targeting hospitals “with the highest activity” of COVID-19 cases.

“We are going to have one to two (trial participants) a day for the next two weeks. And after that point, we will be above our goal of having three patients a day, “said Callum, estimating that it will take six months to study 1,200 patients.

Hwang says his patient was admitted two weeks ago for dementia-related problems, but was tested and diagnosed with COVID-19.

The patient did not show any respiratory symptoms but respiratory problems appeared at the end of last week, and he quickly needed increasing amounts of additional oxygen, Hwang said.

The need for oxygen also qualified the eldest for the trial, says Hwang, and the man was quickly enlisted and randomly selected for a transfusion on the same day, a rapid progression that Hwang reached up to “a little luck “.

“We were preparing for a worsening of things,” said Hwang, an internal medicine specialist.

“Some people are stabilizing, but there was no reason to believe that he was going to handle it himself. He is 78 years old and a fragile man. “

Since then, the man’s breathing has improved, although he still needs additional oxygen this week, Hwang said.

Dr Christine Cserti, a specialist in transfusion medicine at the University Health Network, described a massive coordinated effort to design and implement the trial in just a few weeks as a global pandemic ravages many parts of the world, stifles economies and stretch health care resources.

“What I saw on Friday warmed me endlessly,” said Cserti when he saw the work culminating in the first COVID-19 plasma transfusion in Toronto.

“People really want it to work. “

Of course, the use of convalescent plasma to treat a disease is not new. Among the illnesses it was used for was the 1918 flu epidemic – also known as the Spanish flu.

According to Callum, between five and eight percent of people admitted to hospital receive plasma for other reasons, and this is generally considered a safe procedure.

This allows there to be “1 to 10 percent chance of a transfusion reaction”, but that getting something like COVID-19, HIV, Hepatitis B or West Nile virus from a transfusion is ” like being struck by lightning. “

“These are things we all do sophisticated testing for,” she says. “We feel really reassured about our blood supply. “

A more serious complication is a lung injury called TRALI or transfusion-related acute lung injury, in which the air sacs are flooded with fluid but Cserti rates the risk of this happening “1 in 1,000 to 1 in 100,000”.

If the trial is successful, using plasma transfusions as a standard approach to treat COVID-19 would pose several challenges.

Callum notes that this would require a significant increase in plasma donations, which must come from people under the age of 67 who have fully recovered from COVID-19 and who have been symptom-free for at least 28 days.

“It would be competing for the slots that allow people to donate the platelets we need for people with acute leukemia or heart surgery,” says Callum. “So we need to know that it works. “

Cserti notes that there are cases where a plasma transfusion did not help a COVID-19 patient, and although a highly touted American COVID-19 trial involving 5,000 transfusion subjects suggested that the approach was safe , there was no control group like this smaller Study led by Canada.

“There is always flash and spice in the first anecdotes, right? Said Cserti.

“Everyone says,” Oh, it works so well, “and it’s only when you get a control group next to you that you say,” OK, maybe it’s not much better. . “”

Hwang is optimistic about the benefits, noting that the transfusion appears to reduce the time required for additional oxygen and may allow a patient to get up earlier.

But he does not expect that the treatment will eliminate COVID-19.

“It’s very resource intensive. You have to get donors and go through this long process just to get a plasma unit. And, it’s not even a preventative measure. It’s just (something that is) modulating the disease or increasing the trajectory of, “he says.

“I don’t think it will be our response to COVID, but it may be what will save lives. “

This report from The Canadian Press was first published on May 28, 2020.

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