Plasma Therapy Likely To Be Dropped From Clinical Management Guidelines For COVID-19; Find Out Why?

New Delhi: Some clinicians and scientists have written to Principal Scientific Advisor K Vijay Raghavan cautioning against the “irrational and non-scientific use” of convalescent plasma for COVID-19 in the country.

In the letter, which was also marked to ICMR chief Balram Bhargava and AIIMS Director Randeep Guleria, public health professionals alleged that the current guidelines on plasma therapy are not based on existing evidence and pointed out some very early evidence that indicates a possible association between emergence of variants with lower susceptibility to neutralising antibodies in immunosuppressed” people given plasma therapy, The Indian Express (TIE) reported quoting news agency PTI.

In a meeting of the ICMR-National Task Force for COVID-19 on Friday, all members were in favour of removing the use of convalescent plasma from the Clinical Guidance for Management of Adult COVID-19 Patients citing its ineffectiveness and inappropriate use in several cases, they said. The Indian Council of Medical Research (ICMR) will issue an advisory on the matter soon, they said.

This raises the possibility of more virulent strains developing due to irrational use of plasma therapy which can fuel the pandemic, according to the letter signed by vaccinologist Gagandeep Kang, surgeon Pramesh C S and others.

The present guidelines allow “off-label” use of plasma therapy at the stage of early moderate disease i.e within seven days of the onset of symptoms and if there is the availability of a high tire donor plasma.

In plasma therapy, antibodies from the blood of a patient who has recovered from COVID-19 are used to treat serious patients.

“We are writing to you as concerned clinicians, public health professionals and scientists from India about the irrational and non-scientific use of convalescent plasma for COVID-19 in the country. This has stemmed from guidelines issued by government agencies, and we request your urgent intervention to address the issue which can prevent harassment of COVID-19 patients, their families, their clinicians and COVID-19 survivors,” the letter read, reported PTI.

“The current research evidence unanimously indicates that there is no benefit offered by convalescent plasma for treatment of COVID-19. However, it continues to be prescribed rampantly in hospitals across India,” the letter added.

Families of patients run from pillar-to-post for getting plasma, which is in short supply. The desperation of patients and their families is understandable because they like to try the best for their loved ones when a doctor has prescribed this, the public health professionals were quoted as saying.

ICMR guidelines

The health professionals said ICMR guidelines are not based on the existing evidence.

They cited the ICMR-PLACID trial, which was the world”s first randomised controlled trial on convalescent plasma in 39 public and private hospitals across India.
It found “convalescent plasma was not associated with a reduction in progression to severe COVID-19 or all-cause mortality. This trial has high generalisability and approximates convalescent plasma use in real-life settings with limited laboratory capacity,” the report added.

The large trial of 11,588 patients found no difference in death or proportion of patients discharged from hospital, the clinicians said. Even for those patients who were not on ventilation initially, there was no difference “in the proportion meeting the composite endpoint of progression to invasive mechanical ventilation or death”, they pointed out.

The health professionals added that the Plasma trial in Argentina concluded that there is no significant difference in “clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo”.