RE: FDA EUA24 Aug 2020 19:23
Pros, Cons, and Final Deliberation
I found the below academic article interesting on the use of convalescent plasma. It's not that simple and it has its drawbacks and some benefits. I extracted also part of the conclusion for an quick overview.
https://www.sciencedirect.com/science/article/pii/S0887796320300250
The cons of convalescent plasma include basic administrative and logistical barriers of identifying, consenting, collecting, and testing donors. The efforts of the FDA delineated above should attenuate some of these hindrances. Finding donors with robust humoral response could be a hurdle as well, as not all recovered patients have detectable antibodies in the convalescent stage [39,52]. Additionally, the current lack of widely available and validated SARS-CoV-2 antibody assays, particularly assays detecting neutralizing antibodies, may hamper identification of ideal donors. Concentrating for neutralizing activity may also mitigate potential viral antibody dependent enhancement (ADE), a process in which plasma antibodies exacerbate disease by enhancing viral cell entry and viral replication by various mechanisms, some of which have been described in MERS infectious model [53,54]. Theoretically, ADE could exacerbate COVID-19 infection in patients who receive convalescent plasma from donors who were not tested for SARS-CoV-2 specific neutralizing antibodies. Moreover, the administration of passive antibodies can suppress the recipient’s humoral immune system from generating pathogen-specific antibodies thereby leaving an individual susceptible to reinfection [55].
Of course, there is the rare but non-zero risk of transfusion transmitted infections. However, pathogen reduction could improve the safety profile of convalescent plasma. In fact, one study found that psoralen treatment did not substantially reduce the titers of anti-EBOV specific antibodies or their neutralizing effect [56]. These findings are promising as they indicate that convalescent plasma can be safely modified to reduce infectious risk without disrupting possible efficacy. Finally, there are non-infectious hazards of transfusion [57]. These risks include transfusion reactions such as transfusion related acute lung injury, transfusion associated dyspnea, transfusion circulatory overload, and serve allergic reactions with associated bronchospasm, all of which could worsen respiratory disease in COVID-19 patients, especially those who are already on supplemental oxygen and/or intubated....
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