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J Infect Dis. 2015 Jan 1;211(1):80-90. doi: 10.1093/infdis/jiu396. Epub 2014 Jul 16.

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

Author information

1
East Midlands Centre, Public Health England.
2
Field Epidemiology Training Programme, Public Health England, London Field Epidemiology Service, Public Health England, Liverpool.
3
Roslin Institute, University of Edinburgh, Midlothian.
4
Field Epidemiology Service, Public Health England, Liverpool.
5
Respiratory Medicine, Nottingham University Hospitals NHS Trust.
6
Institute of Care and Practice Improvement, University of the West of Scotland, Hamilton, United Kingdom.
7
Division of Epidemiology and Public Health, University of Nottingham, Nottingham.

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.

KEYWORDS:

MERS coronavirus; convalescent plasma; meta-analysis; severe acute respiratory infection; systematic review

PMID:
25030060
PMCID:
PMC4264590
DOI:
10.1093/infdis/jiu396
[Indexed for MEDLINE]
Free PMC Article

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