@article{Axfors_C-2021_80111,
title = {Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials},
author = {Axfors, C. and Janiaud, P. and Schmitt, A. and Van't Hooft, J. and Smith, E. and Haber, N. and Abayomi, A. and Abduljalil, M. and Abdulrahman, A. and Acosta-Ampudia, Y. and Aguilar-Guisado, M. and Al-Beidh, F. and Alejandria, M. and Alfonso, R. and Ali, M. and AlQahtani, M. and AlZamrooni, A. and Anaya, J. and Ang, M. and Aomar, I. and Argumanis, L. and Averyanov, A. and Baklaushev, V. and Balionis, O. and Benfield, T. and Berry, S. and Birocco, N. and Bonifacio, L. and Bowen, A. and Bown, A. and Cabello-Gutierrez, C. and Camacho, B. and Camacho-Ortiz, A. and Campbell-Lee, S. and Cao, D. and Cardesa, A. and Carnate, J. and Castillo, G. and Cavallo, R. and Chowdhury, F. and Chowdhury, F. and Ciccone, G. and Cingolani, A. and Climacosa, F. and Compernolle, V. and Cortez, C. and Costa Neto, A. and D'Antico, S. and Daly, J. and Danielle, F. and Davis, J. and De Rosa, F. and Denholm, J. and Denkinger, C. and Desmecht, D. and Díaz-Coronado, J. and Díaz Ponce-Medrano, J. and Donneau, A. and Dumagay, T. and Dunachie, S. and Dungog, C. and Erinoso, O. and Escasa, I. and Estcourt, L. and Evans, A. and Evasan, A. and Fareli, C. and Fernandez-Sanchez, V. and Galassi, C. and Gallo, J. and Garcia, P. and Garcia, P. and Garcia, J. and Garigliany, M. and Garza-Gonzalez, E. and Gauiran, D. and Gaviria García, P. and Giron-Gonzalez, J. and Gómez-Almaguer, D. and Gordon, A. and Gothot, A. and Grass Guaqueta, J. and Green, C. and Grimaldi, D. and Hammond, N. and Harvala, H. and Heralde, F. and Herrick, J. and Higgins, A. and Hills, T. and Hines, J. and Holm, K. and Hoque, A. and Hoste, E. and Ignacio, J. and Ivanov, A. and Janssen, M. and Jennings, J. and Jha, V. and King, R. and Kjeldsen-Kragh, J. and Klenerman, P. and Kotecha, A. and Krapp, F. and Labanca, L. and Laing, E. and Landin-Olsson, M. and Laterre, P. and Lim, L. and Lim, J. and Ljungquist, O. and Llaca-Díaz, J. and López-Robles, C. and López-Cárdenas, S. and Lopez-Plaza, I. and Lucero, J. and Lundgren, M. and Macías, J. and Maganito, S. and Malundo, A. and Manrique, R. and Manzini, P. and Marcos, M. and Marquez, I. and Martínez-Marcos, F. and Mata, A. and McArthur, C. and McQuilten, Z. and McVerry, B. and Menon, D. and Meyfroidt, G. and Mirasol, M. and Misset, B. and Molton, J. and Mondragon, A. and Monsalve, D. and Moradi Choghakabodi, P. and Morpeth, S. and Mouncey, P. and Moutschen, M. and Müller-Tidow, C. and Murphy, E. and Najdovski, T. and Nichol, A. and Nielsen, H. and Novak, R. and O'Sullivan, M. and Olalla, J. and Osibogun, A. and Osikomaiya, B. and Oyonarte, S. and Pardo-Oviedo, J. and Patel, M. and Paterson, D. and Peña-Perez, C. and Perez-Calatayud, A. and Pérez-Alba, E. and Perkina, A. and Perry, N. and Pouladzadeh, M. and Poyato, I. and Price, D. and Quero, A. and Rahman, M. and Rahman, M. and Ramesh, M. and Ramírez-Santana, C. and Rasmussen, M. and Rees, M. and Rego, E. and Roberts, J. and Roberts, D. and Rodríguez, Y. and Rodríguez-Baño, J. and Rogers, B. and Rojas, M. and Romero, A. and Rowan, K. and Saccona, F. and Safdarian, M. and Santos, M. and Sasadeusz, J. and Scozzari, G. and Shankar-Hari, M. and Sharma, G. and Snelling, T. and Soto, A. and Tagayuna, P. and Tang, A. and Tatem, G. and Teofili, L. and Tong, S. and Turgeon, A. and Veloso, J. and Venkatesh, B. and Ventura-Enriquez, Y. and Webb, S. and Wiese, L. and Wikén, C. and Wood, E. and Yusubalieva, G. and Zacharowski, K. and Zarychanski, R. and Khanna, N. and Moher, D. and Goodman, S. and Ioannidis, J. and Hemkens, L.},
month = {nov},
year = {2021},
abstract = {BACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.},
volume = {21},
journal = {BMC Infectious Diseases},
publisher = {Springer Nature},
url = {https://doi.org/10.1186/s12879-021-06829-7},
}
