Franchini Massimo, Focosi Daniele, Cruciani Mario, Joyner Michael J, Pirofski Liise-Anne, Senefeld Jonathon W, Shoham Shmuel, Sullivan David J, Casadevall Arturo
Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantua, Italy.
North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy.
Diseases. 2024 Feb 21;12(3):41. doi: 10.3390/diseases12030041.
Plasma collected from people recovered from COVID-19 (COVID-19 convalescent plasma, CCP) was the first antibody-based therapy employed to fight the pandemic. CCP was, however, often employed in combination with other drugs, such as the antiviral remdesivir and glucocorticoids. The possible effect of such interaction has never been investigated systematically. To assess the safety and efficacy of CCP combined with other agents for treatment of patients hospitalized for COVID-19, a systematic literature search using appropriate Medical Subject Heading (MeSH) terms was performed through PubMed, EMBASE, Cochrane central, medRxiv and bioRxiv. The main outcomes considered were mortality and safety of CCP combined with other treatments versus CCP alone. This review was carried out in accordance with Cochrane methodology including risk of bias assessment and grading of the quality of evidence. Measure of treatment effect was the risk ratio (RR) together with 95% confidence intervals (CIs). A total of 11 studies (8 randomized controlled trials [RCTs] and 3 observational) were included in the systematic review, 4 studies with CCP combined with remdesivir and 6 studies with CCP combined with corticosteroids, all involving hospitalized patients. One RCT reported information on both remdesivir and steroids use with CCP. The use of CCP combined with remdesivir was associated with a significantly reduced risk of death (RR 0.74; 95% CI 0.56-0.97; = 0.03; moderate certainty of evidence), while the use of steroids with CCP did not modify the mortality risk (RR 0.72; 95% CI 0.34-1.51; = 0.38; very low certainty of evidence). Not enough safety data were retrieved form the systematic literature analysis. The current evidence from the literature suggests a potential beneficial effect on mortality of combined CCP plus remdesivir compared to CCP alone in hospitalized COVID-19 patients. No significant clinical interaction was found between CCP and steroids.
从新冠康复者体内采集的血浆（新冠康复者血浆，CCP）是用于抗击疫情的首个基于抗体的疗法。然而，CCP常与其他药物联合使用，如抗病毒药物瑞德西韦和糖皮质激素。这种相互作用可能产生的影响从未得到系统研究。为评估CCP联合其他药物治疗新冠住院患者的安全性和疗效，通过PubMed、EMBASE、Cochrane中心、medRxiv和bioRxiv，使用适当的医学主题词（MeSH）进行了系统的文献检索。主要观察指标为CCP联合其他治疗与单独使用CCP相比的死亡率和安全性。本综述按照Cochrane方法进行，包括偏倚风险评估和证据质量分级。治疗效果的衡量指标为风险比（RR）及95%置信区间（CI）。系统评价共纳入11项研究（8项随机对照试验[RCT]和3项观察性研究），4项研究涉及CCP联合瑞德西韦，6项研究涉及CCP联合糖皮质激素，所有研究均纳入住院患者。1项RCT报告了CCP联合使用瑞德西韦和糖皮质激素的信息。CCP联合瑞德西韦使用与死亡风险显著降低相关（RR 0.74；95% CI 0.56 - 0.97；P = 0.03；证据确定性为中等），而CCP联合糖皮质激素使用并未改变死亡风险（RR 0.72；95% CI 0.34 - 1.51；P = 0.38；证据确定性极低）。系统文献分析未检索到足够的安全性数据。目前文献证据表明，与单独使用CCP相比，CCP联合瑞德西韦对新冠住院患者的死亡率可能具有有益影响。未发现CCP与糖皮质激素之间存在显著的临床相互作用。
