Few months ago, there was a hope and presumed scientific reason to believe that plasma therapy will be a wonderful option in Covid pandemic. But the said belief needed to be strengthened by robust trials. As trials continue, the belief that plasma therapy will save lives, have not been proved clear. Now again there is a doubt in the mind of doctors, whether it will save lives or it may not. What ever future may hold, it is clear that it needs more trials, more evidence. Covid virus has again proved to be more smart.
NEW DELHI: A day after TOI reported about an ICMR study that showed administering convalescent plasma to Covid-19 patients did not reduce death risk, top doctors of AIIMS, Institute of Liver and Biliary Sciences (ILBS) and Lok Nayak Hospital stressed the need to rethink who should get the therapy. In the trial by Indian Council of Medical Research, which involved 464 hospitalised, moderately-ill Covid-19 patients, researchers observed that some participants had higher antibody positivity than their plasma donors. “The difference in age and severity of illness, with donors being younger and having milder disease, could have driven this difference. While all Covid-19 survivors were encouraged to donate plasma, an overwhelming majority of the donors were only mildly sick, young survivors. Recovered patients who had moderate or severe disease were generally reluctant to return to hospitals for plasma donation,” the ICMR study noted. Earlier the institutes did not check the level of neutralising antibodies in the donor, which led to poorer outcomes. “The ICMR study re-affirms our assessment based on a trial conducted on 29 patients who received plasma therapy at ILBS. It showed no mortality benefit. However, there was significant benefit in terms of clearing of viral load in those who received the therapy in addition to standard care compared to who received only standard care,” he said. The ILBS director added that only patients with mild-to-moderate illness should be given convalescent plasma. “The therapy has to be given within 24 to 48 hours of diagnosis. Also, detailed assessment of presence of sufficient levels of neutralising antibodies in the donor should be mandatory,” Dr Sarin said. At least 100 Covid-19 patients at the state-run Lok Nayak Hospital have been given plasma therapy till date. Dr Suresh Kumar, its medical director, said larger studies might be needed to assess its benefits. “Remdesivir did not show significant benefit in Covid-19 treatment in some studies. Still, the drug is being used in select patients because it has certain benefits and there is no other known cure. Similarly, plasma therapy may not help reduce death risk but our experience shows it does help in faster recovery in a small subset of patients,” he said. ILBS and Lok Nayak Hospital are conducting a study involving 400 Covid patients to assess the benefits of plasma therapy. Rajiv Gandhi Super Specialty Hospital is also taking part in the study. The ICMR study was conducted at 39 tertiary care hospitals — 29 teaching and 10 private — across the country. According to the study, released on MedRXIV, a preprint service for medicine and health sciences, mortality was documented in 13.6% patients who received plasma therapy in addition to standard care and 31 (14.6%) patients who received only standard care. The trial results also indicated that there was no difference in progression to severe disease among moderately ill patients treated with convalescent plasma along with the best standard of care.