March 17, 2021

Background: Medicine by press release has been an unfortunate reality of the COVID-19 pandemic.  This is not the standard many physicians would use for medical decision making, but one many of us have had to face; what do I do with the information that is presented with no transparency in the data behind the statements? Despite all the debate and controversy only two treatments for hospitalized patients, have been shown to improve mortality: corticosteroids and IL-6 receptor antagonists (when combined with steroids). Two more treatment options that have been debated throughout the pandemic include convalescent plasma therapy and anticoagulation.  We now have two pre-prints that shed some more light on both of these topics.

March 7, 2021

Background: Early observational studies led to the Emergency Use Authorization (EUA) for convalescent plasma therapy (CPT) in the US in August 2020 for the treatment of COVID-19. Data from the RECOVERY trial, the largest clinical trial on COVID-19 treatments was halted early and was communicated as a press release [2] in January 2021.  The preliminary report was based on data from ≈10,000 patients and indicated no significant association of benefit with CPT in reducing all-cause mortality compared with standard of care. Due to this press release the authors of this paper decided to perform a systematic review and meta-analysis to summarize the current literature on the topic.

December 5, 2020

Background: Despite limited high-quality evidence, many institutions are currently using convalescent plasma therapy (CPT) in the treatment of COVID-19.  The majority of the evidence for CPT comes from observational studies lacking placebo arms (US Expanded Access Program). Convalescent plasma therapy isn’t a novel treatment modality and has been used in the treatment of other infectious diseases (SARS, MERS, H1N1, Ebola, etc…) with mixed results. The theory behind CPT is it can supplement the patient’s immune response by administering plasma rich in antibodies from someone previously infected who has recovered.  Thus far the US Expanded Access Program, showed that giving convalescent plasma earlier (i.e. ≤3 days) and with higher titers (>18.45 S/Co) was associated with improved mortality in COVID-19 (This data cannot show causality as there was no randomization and no control arm) [3].

November 13, 2020

Background: There have been lots of trials sitting on my computer desktop awaiting my review, but like many of you time has been thin from clinical work and increasing cases of COVID-19 where I work.  I thought it might be more effective to give you the Cliff’s Notes highlights of each since the time for deep dives remains elusive.  As always, I urge you to read each of the papers yourselves and come to your own conclusions. Thus far in the pandemic, there have been few treatment options available to manage COVID-19. Many clinicians have been using repurposed drugs with scant data as well as other non-drug interventions.  Let’s get into some recent data behind these interventions.

September 24, 2020

Background: Convalescent plasma therapy (CPT) is not a novel treatment modality.  It has been used in other illnesses such as SARS, MERS, and Ebola with variable results. The theory behind CPT is to take antibody rich blood from patients who have recovered from an illness and then administer it to help others recover who currently have the illness.  The US Food and Drug Administration authorized emergency use authorization (EUA) for CPT in patients with COVID-19 (August 2020) based on results from a US Expanded Access Program (EAP) study out of the Mayo Clinic (non-peer reviewed at this time).
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