Background: Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, con- flicting data exist regarding the efficacy of CCP administration in hospitalized patients. Objectives: To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect. Data sources. Electronic databases were searched for studies published from January 2020 to January 2024. Study eligibilky criteria: Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19 Purticipants: Hospitalized patients with COVID-19. Interventions CCP versus no CCP, Assessment of risk of bias: Cochrane risk of bias tool for RCTS. Methods of data synthesis: The random-effects model was used to calculate the pooled risk ratio (RR) with 95% C for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence. Results: Twehty Twenty-seven RCTs included, representing 18.877 hospitalized patients with COVID-19 When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity. Conclusions: In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit. Massimo Franchini, Clin Microbiol Infect 2024:30:1514 (c) 2024 European Society of Clinical Microbiology and Infectious Diseases, Published by Elsevier Ltd. All rights are reserved, including those for text and data mining. Al training, and similar technologies,
[1]Carlo Poma Hosp, Dept Hematol & Transfus Med, I-46100 Mantua, Italy.
[2]Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mol Microbiol & Immunol, Baltimore, MD USA.
[3]Mayo Clin, Dept Anesthesiol & Perioperat Med, Rochester, MN USA.
[4]Albert Einstein Coll Med, Div Infect Dis, Bronx, NY USA.
[5]Montefiore Med Ctr, Bronx, NY USA.
[6]Univ Illinois, Dept Hlth & Kinesiol, Champaign, IL USA.
[7]Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD USA.
[8]Pisa Univ Hosp, North Western Tuscany Blood Bank, Pisa, Italy.
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