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Plasma therapy has been dropped from India’s COVID-19 treatment protocol. The Covid National Task Force released new clinical guidelines for management of mild, moderate and severe Covid cases on May 17, 2021 and they do not mention plasma therapy.
The decision was taken on the basis of recommendations of experts from ICMR-COVID-19 National Task Force, AIIMS and Joint Monitoring Group of Union Health Ministry.
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The members of the ICMR-National Task Force for Covid-19 had met on May 14th during which they had deliberated and discussed upon the effectiveness or ineffectiveness of plasma therapy.
•Plasma therapy has been largely used as a medium to treat COVID-19 patients, especially the severe cases since the onset of the COVID-19 pandemic.
•However, lately doubts were raised over its effectiveness in treating the COVID-19 patient.
•During its recent meeting, all members of the national covid task force were in favour of removing the use of convalescent plasma therapy from the Clinical Guidance for Management of Adult COVID-19 patients citing its ineffectiveness and inappropriate use in several cases.
•The decision was taken as convalescent plasma was seen to offer no therapeutic benefits in patients admitted to hospital with the disease.
•The Indian Council of Medical Research (ICMR) is expected to issue an advisory on the matter soon.
What is Plasma Therapy?
The plasma therapy involves transfusion of COVID-19 antibodies from the blood of a recovered patient to the one being treated to aid faster recovery.
What is plasma?
Plasma is the clear liquid portion of the blood that remains after red and white blood cells, platelets and other cellular components have been removed from it.
Who can give plasma?
The Convalescent plasma is extracted from the blood of patients who have recovered from COVID-19 and who have sufficient antibodies against the infection.
India’s clinical management protocol for COVID-19 had so far recommended off-label use of convalescent plasma under two specific criteria:
Early moderate disease, preferably within seven days of symptoms once and no use after seven days
Availability of high titre donor plasma
How effective has plasma therapy been?
The plasma therapy has not been found effective in reducing the progression of the infection to severe nor has it been able to decrease the fatality rate.
•The central health expert’s decision to drop convalescent plasma as a recommended therapy for management of COVID-19 comes three days after publishing of the findings of the RECOVERY Trial (Randomised Evaluation of COVID-19 Therapy) in the Lancet medical journal.
•The RECOVERY Trial was the largest randomised trial conducted to investigate whether treatment with Convalescent plasma, Lopinavir-Ritonavir, Hydroxychloroquine, Corticosteroids, Azithromycin, Colchicine, IV Immunoglobulin (children only), Synthetic neutralizing antibodies (REGN-COV2), Tocilizumab, Aspirin, Baricitinib, Infliximab or Anakinra (children only) has been effective in patients hospitalised with Covid-19
•The trial data showed that compared with usual care alone, high-titre convalescent plasma did not reduce 28-day mortality.
•It showed that high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes in patients hospitalised with Covid-19.
•The results of RECOVERY trial were published on May 14, 2021.
•India’s largest trial, PLACID trial had also concluded that convalescent plasma is ineffective for treating COVID-19.
•The PLACID trial had mainly evaluated the effectiveness of convalescent plasma for the treatment of moderate covid-19 in patients admitted to hospital in India.
•The PLACID Trial investigators found that there was no net benefit associated with convalescent plasma in patients admitted to hospital with moderate covid-19.
•Though the convalescent plasma did exactly what the investigators hoped it would do, yet there was no net clinical benefit to patients.
•After the publication of the PLACID trial data, ICMR had issued an evidence-based advisory to address the inappropriate use of convalescent plasma in Covid-19 patients.
•ICMR had emphasised that convalescent plasma with a low concentration of specific antibodies against SARS-CoV-2 may be less beneficial in the treatment of Covid-19 patients compared to plasma with high concentration of such antibodies.
With the surge in cases in the country, there was also a rise in demand for plasma donors, even as experts raised concerns over the efficacy of plasma therapy for Covid-19 patients.
A group of medical practitioners had earlier written to Principal Scientific Advisor K Vijay Raghavan cautioning against the ‘irrational and non-scientific use’ of convalescent plasma for COVID-19.