Convalescent Plasma for Infectious Diseases: Historical Framework and Use in COVID-19

This review briefly describes SARS-CoV-2 and its clinical implications, discusses the mechanisms of passive immunotherapy, outlines the historical precedent for antibody-based therapies, and concludes with a summary of evidence behind the use of convalescent plasma for treatment of COVID-19.

Highlights include:

  • Convalescent plasma therapy has been successfully used to treat a myriad of infectious diseases since the 1890s, including the Spanish influenza, mumps, polio, measles and bacterial infections. It also served as the foundation for vaccine development in the 20th century.
  • Since the discovery of antibiotics, the interest in antibodies as therapeutic agents for infectious diseases has largely been in the context of epidemics or pandemics.
  • The review examines the historical use of convalescent plasma in the management of two recent CoV epidemics with high mortality rates: the 2003 SARS-CoV-1 epidemic, originating in Hong Kong, and the 2012 MERS-CoV epidemic, which originated in Saudi Arabia. It also provides data from studies of Argentine hemorrhagic fever, the 2009-2010 H1N1 influenza pandemic, the 2013 West African Ebola epidemic and other cases.
  • The authors discuss the use of convalescent plasma for treatment of COVID-19, including barriers to donor recruitment, nuances of the neutralizing antibody response, and the safety profile and efficacy signals for COVID-19 convalescent plasma.
  • The review shows that in the context of COVID-19, available data indicate that convalescent plasma provides clinical and mortality benefits for hospitalized patients and that the benefit of convalescent plasma is most apparent in patients transfused with plasma containing high anti-SARS-CoV-2 antibody levels early in the disease course.