Covid-19: Experts caution against 'irrational and non-scientific use' of convalescent plasma

Some clinicians and scientists have written to Principal Scientific Advisor K Vijay Raghavan cautioning against the irrational and nonscientific use of convalescent plasma for Covid19 in the countryThe public health professionals said the current evidence on plasma therapy in Covid19 and the Indian Council of Medical Research ICMR guidelines are not based on the existing evidenceThey also pointed out some very early evidence that indicates a possible association between emergence of variants with ldquolower susceptibility to neutralising antibodies in immunosuppressed people given plasma therapyThis raises the possibility of more virulent strains developing due to irrational use of plasma therapy which can fuel the pandemic the letter signed by experts like vaccinologist Gagandeep Kang and surgeon Pramesh C S saidWe 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 Covid19 in the country it saidThis has stemmed from guidelines issued by government agencies and we request your urgent intervention to address the issue which can prevent harassment of Covid19 patients their families their clinicians and Covid19 survivorsrdquo said the letter which was also marked to Director General of the Indian Medical Council of India Balram Bhargav and AIIMS Director Randeep GuleriaThe concerns were raised after the Union Health Ministry last month issued an updated revised Clinical Guidance for Management of Adult Covid19 Patients under which it recommended offlabel use of convalescent plasma only in the early moderate disease preferably within seven days of symptom onsetIt also stated that no use after seven days and only on availability of high titre donor plasmaThe current research evidence unanimously indicates that there is no benefit offered by convalescent plasma for treatment of Covid19 However it continues to be prescribed rampantly in hospitals across Indiardquo the letter saidFamilies of patients run from pillartopost 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 saidIn the plasma therapy antibodies from the blood of a patient who has recovered from Covid19 are used to treat serious patientsThey said the current evidence on plasma therapy in Covid19 and the ICMR guidelines are not based on the existing evidenceThey cited the ICMRPLACID trial which was the worlds first randomised controlled trial on convalescent plasma in 39 public and private hospitals across IndiaIt found convalescent plasma was not associated with a reduction in progression to severe Covid19 or allcause mortality This trial has high generalisability and approximates convalescent plasma use in real life settings with limited laboratory capacityThe large trial of 11588 patients found no difference in death or proportion of patients discharged from hospital the clinicians saidEven 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 outThe health professionals added that the PlasmAr trial the trial from Argentina concluded that there is no significant difference in ldquoclinical status or overall mortality between patients treated with convalescent plasma and those who received placebordquoCurrent research evidence unanimously indicates that there is no benefit offered by convalescent plasma for treatment of Covid19 However it continues to be prescribed rampantly in hospitals across India they saidThe problematic scenario arises because of guidelines issued by ICMRAIIMS which currently recommends plasma therapy April 2021 version as off label use This is rather unusual as offlabel use by its very definition implies unapproved use the letter saidThe letter added that guidelines from the National Institutes of Health NIH in the US and the Infectious Diseases Society of America IDSA also recommend against general use of plasma therapy for Covid19This story has been sourced from a third party syndicated feed agencies Midday accepts no responsibility or liability for its dependability trustworthiness reliability and data of the text Midday managementmiddaycom reserves the sole right to alter delete or remove without notice the content in its absolute discretion for any reason whatsoever