Convalescent Plasma in Outpatients With COVID-19

Stanford University511 enrolled

Overview

The overarching goal of this project is to confirm or refute the role of passive immunization as a safe and efficacious therapy in preventing the progression from mild to severe/critical COVID-19 illness and to understand the immunologic kinetics of anti-SARS-CoV-2 antibodies after passive immunization.The primary objective is to determine the efficacy and safety of a single dose of convalescent plasma (CP) for preventing the progression from mild to severe COVID-19 illness. The secondary objective is to characterize the immunologic response to CP administration. This study will enroll adults presenting to the emergency department (ED) with mild, symptomatic, laboratory-confirmed COVID-19 illness, who are at high risk for progression to severe/critical illness, but who are clinically stable for outpatient management at randomization.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

511

Conditions

Covid19

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * One or more symptoms of COVID-19 illness and laboratory-confirmed SARS-CoV-2 infection * Has at least one study defined risk factor for severe COVID-19 illness * Clinical team deems stable for outpatient management without supplemental oxygen * CP available at the site at the time of enrollment * Duration of symptoms ≤ 7 days at ED presentation * Informed consent from subject Exclusion Criteria: * Age less than 18 years * Prisoner or ward of the state * Presumed unable to complete follow-up assessments * Prior adverse reaction(s) from blood product transfusion * Receipt of any blood product within the past 120 days * Treating clinical team unwilling to administer 300 ml fluid * Enrollment in another interventional trial for COVID-19 illness

Locations (53)

Chandler Regional Medical Center

Chandler, Arizona, United States

Valleywise Health Medical Center

Phoenix, Arizona, United States

UCSD Health La Jolla

La Jolla, California, United States

Loma Linda University Medical Center

Loma Linda, California, United States

Ronald Reagan UCLA Medical Center

Los Angeles, California, United States

Outcomes

Primary Outcomes

Number of Patients With Disease Progression (Intention-to-treat Population)

Disease progression defined as death or hospital admission or seeking emergency or urgent care within 15 days of randomization.

Time frame: 15 days

Number of Patients With Disease Progression (Per-protocol Population)

Disease progression defined as death or hospital admission or seeking emergency or urgent care within 15 days of randomization.

Time frame: 15 days

Secondary Outcomes

Worst Severity Rating on the WHO COVID Ordinal Scale for Clinical Improvement During the 30 Days Following Randomization

This scale was developed by a special World Health Organization (WHO) committee for quantifying COVID-19 illness severity. * 1 = Not hospitalized without limitation in activity (no symptoms) * 2 = Not hospitalized with limitation in activity (continued symptoms) * 3 = Hospitalized not on supplemental oxygen * 4 = Hospitalized on supplemental oxygen by mask or nasal prongs * 5 = Hospitalized on non-invasive ventilation or high flow nasal cannula * 6 = Hospitalized, intubated and mechanically ventilated * 7 = Hospitalized, intubated, mechanically ventilated and requiring additional organ support (pressors, renal replacement therapy) * 8 = Death

Time frame: 30 days

Number of Patients With Worsening of Symptoms at Day 15 as a Measure of Time to Disease Progression

Assessed on the COVID Outpatient Ordinal Outcome Scale censored at 15 days after randomization. Scale provides more granular detail for outpatients than the WHO scale (adapted from Harrell and Lindsell, 2020). Worsening of symptoms is defined as any subject admitted to the hospital (level 1), seen in the emergency room (level 2), a patient who reports increased symptoms of 2 levels on the scale over a 24 hour period, or a patient who reports increased symptoms of 1 level observed for a 48 hour period. COVID Outpatient Ordinal Outcomes Scale * 1 = patient requires care in the hospital * 2 = patient requires care in the emergency department or urgent care * 3 = patient at home with symptoms rated as moderate (defined as fever, shortness of breath, abdominal pain) * 4 = patient at home with symptoms rated as mild (defined as afebrile, constitutional symptoms (flu-like illness) without shortness * 5 = patient in their usual state of health

Time frame: 15 days

Number of Hospital-free Days During the 30 Days Following Randomization

Time frame: 30 days

All-cause Mortality

Time frame: Assessed at 30 days