Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19

ABSTRACT Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. Additionally, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 (“vax-plasma”). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19 specific therapeutics (standard of care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard of care group, which corresponded to a relative risk reduction of 65% (P=0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19 specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCE As SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged which evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19 specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients..

Medienart:	Preprint

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	bioRxiv.org - (2024) vom: 23. Apr. Zur Gesamtaufnahme - year:2024

Sprache:	Englisch

Beteiligte Personen:

Ripoll, Juan G. [VerfasserIn] Tulledge-Scheitel, Sidna M. [VerfasserIn] Stephenson, Anthony A. [VerfasserIn] Ford, Shane [VerfasserIn] Pike, Marsha L. [VerfasserIn] Gorman, Ellen K. [VerfasserIn] Hanson, Sara N. [VerfasserIn] Juskewitch, Justin E. [VerfasserIn] Miller, Alex J. [VerfasserIn] Zaremba, Solomiia [VerfasserIn] Ovrom, Erik A. [VerfasserIn] Razonable, Raymund R. [VerfasserIn] Ganesh, Ravindra [VerfasserIn] Hurt, Ryan T. [VerfasserIn] Fischer, Erin N. [VerfasserIn] Derr, Amber N. [VerfasserIn] Eberle, Michele R. [VerfasserIn] Larsen, Jennifer J. [VerfasserIn] Carney, Christina M. [VerfasserIn] Theel, Elitza S. [VerfasserIn] Parikh, Sameer A. [VerfasserIn] Kay, Neil E. [VerfasserIn] Joyner, Michael J. [VerfasserIn] Senefeld, Jonathon W. [VerfasserIn]

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Themen:	570 Biology

doi:	10.1101/2023.08.29.23293790

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PPN (Katalog-ID):	XBI040702677