COVID-19 research briefs: (1) a case series of convalescent sera, and (2) a negative trial of hydroxychloroquine

Daily POEMs

Published: 2020-04-11 © 2020 John Wiley & Sons, Inc.

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Clinical question
Can convalescent sera or hydroxychloroquine improve outcomes in people with COVID-19 infection?

Bottom line
Very preliminary evidence suggests that convalescent sera is a promising intervention for the treatment of patients with the novel coronavirus disease 2019 (COVID-19), while the initial randomized trial of hydroxychloroquine in 30 patients found no evidence of benefit. (LOE = 2c)

Shen C, Wang Z, Zhao F, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA 2020 Mar 27 [Online ahead of print]. Doi: 10.1001/jama.2020.4783. Chen, J, Liu Danping, Liu Li, et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease (COVID-19). J Zhejiang Univ (Med Sci) 2020; 49 (1):0-0. doi: 10.3785/j.issn.1008-9292.2020.03.03.

Study design: Not applicable

Funding source: Unknown/not stated

Setting: Inpatient (any location)

Research Brief #1 (Shen, 2020) A case series identified 5 patients with severe COVID-19 pneumonia and acute respiratory distress syndrome (ARDS) who were mechanically ventilated and had a PaO2/FIO2 of less than 300. They were all given convalescent sera between 10 days and 22 days after admission. The patients were aged 36 years to 65 years and 2 were women. After the transfusion of convalescent sera, fever resolved in 4 of 5 patients within 3 days and ARDS resolved in 4 of 5 patients within 12 days. At the time of this writing, 3 patients had been discharged from the hospital and 2 patients were in stable condition. Although these results are promising, clinical trials are needed given this study's small number of patients and uncontrolled design. Research Brief #2 (Chen, 2020) In this initial report of a small randomized trial in Shanghai, China, 30 patients with COVID-19 infection were randomized to receive hydroxychloroquine (HCQ) 400 mg per day for 5 days plus usual care or usual care alone. At 7 days, there was no difference in the rates of negative viral swabs by polymerase chain reaction (87% in the HCQ group vs 93% in the control group). There was also no difference regarding the incidence of severe disease (1 patient in the HCQ group and none in the usual care group), time to discharge, and time to being afebrile. Although larger trials are ongoing, these results are not encouraging.

Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Copyright © 2020 John Wiley & Sons, Inc.