Thread by @tmprowell

📣#Preprint #COVID19 #ConvalescentPlasma
📌RCT (N=1.2K)
📌Outpatients age 18+
📌High-titer CCP (>1:320) vs placebo plasma w/in 9d of symptoms
📌Primary endpt: Hosp/death by d28
📌CCP 🏆: 54% ⬇️, driven by non-ICU hospitalizations (NNT=29); HR 0.46, p<.01
medrxiv.org/content/10.110…

2/ A few important points about this #COVID19 #convalescentplasma trial
📌High-titer CCP was much higher than that used in some other studies (median titer of >1:14,580 & 95% had >1:4820)
📌Median days to plasma: 6d
📌53 of 54 hospitalizations were in unvaxxed (#GetVaccinated!)

3/ 📌 Only 3 deaths in post-hosp period, all in controls
📌 Few #COVID19nCancer or #immunocompromised
📌 Study used #convalescent plasma mostly from Apr-Dec 2020 (ie pre-#vaccine availability)
📌Would *predict* CCP from #vaccinated to perform well vs #Omicron & #covidvariants

4/ An IMMENSE labor of love to get this #COVID19 #convalescentplasma trial done with:
👉 Cases surging & subsiding
👉 Emergence of monoclonal antibodies
👉 Considerable skepticism from #MedTwitter

Congrats to authors! Results important as most mAb now ineffective vs #Omicron.

5/ We now have #Paxlovid authorized in last 24h. Game-changing with 89% ⬇️ in hosp/death for same pop of outpatients (+ age 12-17). BUT current/projected supply is inadequate for #Omicron surge we are facing & it must be given within 5d of symptom onset. Thus, CCP is relevant.

Disclosures: No financial or other conflicts of interest, except lots of #OslerPride 😄

7/ In summary, I think results are relevant to now, given #Omicron surge, within shifting therapeutic landscape (sev mAb, but most limited efficacy vs current #CovidVariant; oral antiviral very effective but a limited supply & use hampered by 🇺🇸 lack of timely access to tests).

8/ But I’ll close by stating the obvious: #VaccinesWork. All but 1 hospitalized in this study were unvaccinated. It’s true we are seeing more infections w/ #Omicron despite vaccination & even #boostershots, but hospitalizations in this 3-vax group remain pretty low.

9/ It won’t be easy to give #convalescentplasma at a time that our health care system is drowning in an #Omicron surge w/o a lot of added capacity we don’t have. The challenge of getting mAb infusions recently is a preview. /End this accompanying editorial no one asked me for 😂