The Effectiveness of Convalescent Plasma and Hyperimmune Immunoglobulin for the Treatment of Severe Acute Respiratory Infections of Viral Etiology: A Systematic Review and Exploratory Meta-analysis

Convalescent Plasma Study Group, John Mair-Jenkins, Maria Saavedra-Campos, J Kenneth Baillie, Paul Cleary, Fu-Meng Khaw, Wei Shen Lim, Sophia Makki, Kevin D Rooney, Charles R Beck

Research output: Contribution to journalLiterature reviewpeer-review

Abstract

BACKGROUND: Administration of convalescent plasma, serum, or hyperimmune immunoglobulin may be of clinical benefit for treatment of severe acute respiratory infections (SARIs) of viral etiology. We conducted a systematic review and exploratory meta-analysis to assess the overall evidence.

METHODS: Healthcare databases and sources of grey literature were searched in July 2013. All records were screened against the protocol eligibility criteria, using a 3-stage process. Data extraction and risk of bias assessments were undertaken.

RESULTS: We identified 32 studies of SARS coronavirus infection and severe influenza. Narrative analyses revealed consistent evidence for a reduction in mortality, especially when convalescent plasma is administered early after symptom onset. Exploratory post hoc meta-analysis showed a statistically significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, .14-.45; I(2) = 0%). Studies were commonly of low or very low quality, lacked control groups, and at moderate or high risk of bias. Sources of clinical and methodological heterogeneity were identified.

CONCLUSIONS: Convalescent plasma may reduce mortality and appears safe. This therapy should be studied within the context of a well-designed clinical trial or other formal evaluation, including for treatment of Middle East respiratory syndrome coronavirus CoV infection.

Original languageEnglish
Pages (from-to)80-90
Number of pages11
JournalThe Journal of Infectious Diseases
Volume211
Issue number1
Early online date16 Jul 2014
DOIs
Publication statusPublished - 1 Jan 2015

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