The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review

Mair-Jenkins, John and Saavedra-Campos, Maria and Baillie, J. Kenneth and Cleary, Paul and Khaw, Fu-Meng and Lim, Wei Shen and Makki, Sophia and Rooney, Kevin D and Beck, Charles R. and Nguyen-Van-Tam, Jonathan S. (2014) The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review. Journal of Infectious Diseases, 211 (1). pp. 80-90. ISSN 1537-6613

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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.

Item Type: Article
Keywords: MERS coronavirus; convalescent plasma; severe acute respiratory infection; systematic review; meta-analysis
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
Identification Number: https://doi.org/10.1093/infdis/jiu396
Related URLs:
URLURL Type
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264590/UNSPECIFIED
Depositing User: Claringburn, Tara
Date Deposited: 19 Oct 2016 10:56
Last Modified: 19 Oct 2016 15:12
URI: http://eprints.nottingham.ac.uk/id/eprint/37680

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