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

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Mair-Jenkins, John, Saavedra-Campos, Maria, Baillie, J. Kenneth, Cleary, Paul, Khaw, Fu-Meng, Lim, Wei Shen, Makki, Sophia, Rooney, Kevin D, 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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Official URL: http://jid.oxfordjournals.org/content/211/1/80

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

RIS ID:

https://nottingham-repository.worktribe.com/output/732362

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

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