{"doi":"10.1001/jama.2021.2747","title":"Association of Convalescent Plasma Treatment With Clinical Outcomes in Patients With COVID-19","abstract":"<h4>Importance</h4>Convalescent plasma is a proposed treatment for COVID-19.<h4>Objective</h4>To assess clinical outcomes with convalescent plasma treatment vs placebo or standard of care in peer-reviewed and preprint publications or press releases of randomized clinical trials (RCTs).<h4>Data sources</h4>PubMed, the Cochrane COVID-19 trial registry, and the Living Overview of Evidence platform were searched until January 29, 2021.<h4>Study selection</h4>The RCTs selected compared any type of convalescent plasma vs placebo or standard of care for patients with confirmed or suspected COVID-19 in any treatment setting.<h4>Data extraction and synthesis</h4>Two reviewers independently extracted data on relevant clinical outcomes, trial characteristics, and patient characteristics and used the Cochrane Risk of Bias Assessment Tool. The primary analysis included peer-reviewed publications of RCTs only, whereas the secondary analysis included all publicly available RCT data (peer-reviewed publications, preprints, and press releases). Inverse variance-weighted meta-analyses were conducted to summarize the treatment effects. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation.<h4>Main outcomes and measures</h4>All-cause mortality, length of hospital stay, clinical improvement, clinical deterioration, mechanical ventilation use, and serious adverse events.<h4>Results</h4>A total of 1060 patients from 4 peer-reviewed RCTs and 10 722 patients from 6 other publicly available RCTs were included. The summary risk ratio (RR) for all-cause mortality with convalescent plasma in the 4 peer-reviewed RCTs was 0.93 (95% CI, 0.63 to 1.38), the absolute risk difference was -1.21% (95% CI, -5.29% to 2.88%), and there was low certainty of the evidence due to imprecision. Across all 10 RCTs, the summary RR was 1.02 (95% CI, 0.92 to 1.12) and there was moderate certainty of the evidence due to inclusion of unpublished data. Among the peer-reviewed RCTs, the summary hazard ratio was 1.17 (95% CI, 0.07 to 20.34) for length of hospital stay, the summary RR was 0.76 (95% CI, 0.20 to 2.87) for mechanical ventilation use (the absolute risk difference for mechanical ventilation use was -2.56% [95% CI, -13.16% to 8.05%]), and there was low certainty of the evidence due to imprecision for both outcomes. Limited data on clinical improvement, clinical deterioration, and serious adverse events showed no significant differences.<h4>Conclusions and relevance</h4>Treatment with convalescent plasma compared with placebo or standard of care was not significantly associated with a decrease in all-cause mortality or with any benefit for other clinical outcomes. The certainty of the evidence was low to moderate for all-cause mortality and low for other outcomes.","journal":"JAMA","year":2021,"id":8917,"datarank":0.8436026259281009,"base_score":5.6240175061873385,"endowment":5.6240175061873385,"self_citation_contribution":0.8436026259281009,"citation_network_contribution":0.0,"self_endowment_contribution":0.8436026259281009,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":276,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.2909,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-03-23","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":3829,"name":"Cathrine Axfors","orcid":"0000-0002-2706-1730","position":1,"is_corresponding":false},{"id":3830,"name":"Andreas M. 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