Updated: November 19, 2020 3:24:26 am
THE INDIAN Council of Medical Research (ICMR) released a fresh advisory on convalescent plasma therapy on Tuesday, warning against “indiscriminate use” and advising doctors to use it only in the early stage of Covid-19.
In Maharashtra, the state task force said it had advised doctors that if they were going to administer plasma therapy, it had to be within 48 to 72 hours of hospitalisation.
Dr Shashank Joshi, part of the Covid task force, said a multi-centre plasma trial had been planned, involving public and private hospitals to generate data on its effects in patients administered therapy early on during the treatment.
“We have recommended its use within eight days of the patient being admitted. The sooner the better,” said Joshi, adding that approval for the trials were pending.
On Tuesday, the ICMR stated that the Placid trial, the largest in the world, on 464 moderately ill Covid patients across 39 hospital sites did not lead to reduction in mortality or prevent progression of disease into severe form.
It, however, recommended that if doctors wish to use, they must select donor plasma with high neutralising antibodies that should be transfused in a patient within three to seven days of developing symptoms and not later than 10 days. The Placid trial’s Phase I findings have been released, but Phase II findings are underway. No trial in India has, so far, focused on plasma efficacy if used early.
Dr Rahul Pandit, intensivist at Fortis hospital, said plasma was most effective when used within three to five days of developing symptoms. “But it is practically impossible to use it that early because patients seek hospitalisation at least three to four days after developing symptoms. After eight to 10 days of symptoms, plasma does little to improve a patient,” he said.
Availability of donors also remains a problem. Patients are expected to find a plasma donor with blood banks unable to encourage participation of recovered patients in mass donation drives.
Only a few hospitals continue to measure neutralising antibody titers in donors before extracting the plasma. Pandit said the plasma must have 60 to 70 per cent of neutralising antibodies to work in a patient. He added that the task force had advised doctors in the city to not use plasma therapy for all Covid-19 patients, and only on those who they believed could turn critical.
The ICMR guidelines have advised donors must have neutralising antibody titer of 1:80, weigh above 50 kg, and should be aged between 18 and 65 years.
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