CHEST Guidelines-Response_chest

Response_chest_35

Pdf Summary

The correspondence focuses on the PassITON trial, which evaluated the efficacy of convalescent plasma (CCP) as an adjunct to standard COVID-19 care in hospitalized patients. The trial faced criticism for showing no significant benefit of CCP, potentially due to concurrent treatments with remdesivir—an antiviral medication used by roughly 80% of patients in the trial—complicating the evaluation of CCP's standalone efficacy. Authors Arturo Casadevall and Jeffrey P. Henderson argue that many patients in the trial received CCP alongside other antiviral therapies, limiting the ability to assess CCP's true potential.<br /><br />The PassITON trial was rigorous, involving 960 individuals across 25 hospitals, and adhered to blinded, placebo-controlled standards to ensure robust methodology. However, the results were null, showing no significant benefit of CCP over placebo. Authors of the trial's response letter indicated that the trial was not designed to ascertain CCP's standalone efficacy since patients received concurrent treatments consistent with standard care, such as corticosteroids and remdesivir.<br /><br />The trial's analysis found no advantage in early administration of CCP for those hospitalized with COVID-19. Additionally, criticisms included the timing of hospitalization post-symptom onset, as the majority of patients were admitted beyond a hypothesized optimal treatment window of three days post-symptom onset. The plasma used was tested for high titers of binding antibodies to SARS-CoV-2, though only a subset showed confirmed neutralizing activity, which might have affected outcomes.<br /><br />Ultimately, the correspondence emphasizes the challenges of rapidly evolving therapeutic standards and highlights the complexities in evaluating combination and standalone treatments for COVID-19. The authors assert PassITON's findings are crucial but highlight the necessity for ongoing research into optimizing COVID-19 treatments.

Keywords

PassITON trial

convalescent plasma

COVID-19

remdesivir

hospitalized patients

Arturo Casadevall

Jeffrey P. Henderson

blinded placebo-controlled

antiviral therapies

neutralizing antibodies