Cochrane · systematic review · CD013600
Convalescent plasma for people with COVID‐19: a living systematic review
Iannizzi, C, Chai, KL, Piechotta, V, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
32
current version
GRADE rated
19
No studies
13
Included studies
NR
No studies 13 · 40.6%Ungraded 0 · 0%Very low 6 · 18.8%Low 8 · 25%Moderate 2 · 6.3%High 3 · 9.4%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with moderate to severe disease
Population: individualswith moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 ‐ total Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.98 [0.92, 1.03] | 21 studies · 19021 participants | High |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.03 [0.97, 1.11] | 6 studies · 14477 participants | High |
Clinical improvement: participants discharged from hospital Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1 [0.97, 1.02] | 6 studies · 12721 participants | High |
Quality of life, Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 483 participants | Low Downgraded: imprecision |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.17 [0.96, 1.42] | 6 studies · 2392 participants | Low Downgraded: inconsistency, indirectness, publication bias |
Serious adverse events ‐ total Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.14 [0.91, 1.44] | 6 studies · 3901 participants | Moderate Downgraded: publication bias |
Summary of findings table ‐ Convalescent plasma compared to standard plasma for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.73 [0.45, 1.19] | 4 studies · 484 participants | Very low Downgraded: imprecision, inconsistency |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 5.59 [0.29, 108.38] | 1 study · 34 participants | Very low Downgraded: imprecision |
Clinical improvement: participants discharged from hospital ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Quality of life, Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | 1 study · 248 participants | Very low Downgraded: imprecision, indirectness |
Serious adverse events Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.8 [0.55, 1.15] | 3 studies · 327 participants | Very low Downgraded: imprecision, publication bias |
Summary of findings table ‐ Convalescent plasma compared to human immunoglobulin for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | RR 1.07 [0.76, 1.5] | 1 study · 190 participants | Low Downgraded: imprecision |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Clinical improvement: participants discharged from hospital ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Summary of findings table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with mild disease
Population: outpatients withmild disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | OR 0.36 [0.09, 1.46] | 2 studies · 536 participants | Very low Downgraded: imprecision, indirectness |
Admission to hospital or death within 28 days Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.05 [0.6, 1.84] | 1 study · 376 participants | Low Downgraded: imprecision |
Symptom resolution‐ all initial symptoms resolved ‐ not reported Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | NR | No studies |
Time to symptom resolution (absolute effect calculated for day 12) Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | HR 1.05 [0.85, 1.3] | 1 study · 376 participants | Low Downgraded: imprecision |
Quality of life, Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.29 [0.75, 2.19] | 1 study · 376 participants | Low Downgraded: imprecision |
Serious adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.14 [0.66, 1.94] | 1 study · 376 participants | Low Downgraded: imprecision |
Summary of findings table ‐ Convalescent plasma compared to standard plasma for outpatients with mild disease
Population: outpatients withmild disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | OR 0.3 [0.05, 1.75] | 2 studies · 1597 participants | Very low Downgraded: imprecision |
Admission to hospital or death within 28 days Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.49 [0.31, 0.75] | 2 studies · 1595 participants | Moderate Downgraded: imprecision |
Symptom resolution‐ all initial symptoms resolved Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 1.12 [0.98, 1.27] | 1 study · 416 participants | Low Downgraded: imprecision |
Time to symptom resolution ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Quality of life, Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Summary of findings table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with moderate to severe disease
Population: individualswith moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 ‐ total Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.98 [0.92, 1.03] | 21 studies · 19021 participants | High |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.03 [0.97, 1.11] | 6 studies · 14477 participants | High |
Clinical improvement: participants discharged from hospital Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1 [0.97, 1.02] | 6 studies · 12721 participants | High |
Quality of life, Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 483 participants | Low Downgraded: imprecision |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.17 [0.96, 1.42] | 6 studies · 2392 participants | Low Downgraded: inconsistency, indirectness, publication bias |
Serious adverse events ‐ total Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.14 [0.91, 1.44] | 6 studies · 3901 participants | Moderate Downgraded: publication bias |
Summary of findings table ‐ Convalescent plasma compared to standard plasma for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.73 [0.45, 1.19] | 4 studies · 484 participants | Very low Downgraded: imprecision, inconsistency |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 5.59 [0.29, 108.38] | 1 study · 34 participants | Very low Downgraded: imprecision |
Clinical improvement: participants discharged from hospital ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Quality of life, Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | 1 study · 248 participants | Very low Downgraded: imprecision, indirectness |
Serious adverse events Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.8 [0.55, 1.15] | 3 studies · 327 participants | Very low Downgraded: imprecision, publication bias |
Summary of findings table ‐ Convalescent plasma compared to human immunoglobulin for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | RR 1.07 [0.76, 1.5] | 1 study · 190 participants | Low Downgraded: imprecision |
Clinical worsening: need for invasive mechanical ventilation, or death at up to day 28 ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Clinical improvement: participants discharged from hospital ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Quality of life ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs human immunoglobulin | no estimate extracted | NR | No studies |
Summary of findings table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with mild disease
Population: outpatients withmild disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | OR 0.36 [0.09, 1.46] | 2 studies · 536 participants | Very low Downgraded: imprecision, indirectness |
Admission to hospital or death within 28 days Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.05 [0.6, 1.84] | 1 study · 376 participants | Low Downgraded: imprecision |
Symptom resolution‐ all initial symptoms resolved ‐ not reported Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | NR | No studies |
Time to symptom resolution (absolute effect calculated for day 12) Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | HR 1.05 [0.85, 1.3] | 1 study · 376 participants | Low Downgraded: imprecision |
Quality of life, Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.29 [0.75, 2.19] | 1 study · 376 participants | Low Downgraded: imprecision |
Serious adverse events Summary of findings table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.14 [0.66, 1.94] | 1 study · 376 participants | Low Downgraded: imprecision |
Summary of findings table ‐ Convalescent plasma compared to standard plasma for outpatients with mild disease
Population: outpatients withmild disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of findings table ‐ Convalescent plasma vs standard plasma | OR 0.3 [0.05, 1.75] | 2 studies · 1597 participants | Very low Downgraded: imprecision |
Admission to hospital or death within 28 days Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 0.49 [0.31, 0.75] | 2 studies · 1595 participants | Moderate Downgraded: imprecision |
Symptom resolution‐ all initial symptoms resolved Summary of findings table ‐ Convalescent plasma vs standard plasma | RR 1.12 [0.98, 1.27] | 1 study · 416 participants | Low Downgraded: imprecision |
Time to symptom resolution ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Quality of life, Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Grades 3 and 4 adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of findings table ‐ Convalescent plasma vs standard plasma | no estimate extracted | NR | No studies |
Summary of Findings Table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 ‐ total Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.98 [0.92, 1.05] | 7 studies · 12646 participants | High |
Clinical improvement, assessed by liberation from respiratory support Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 8 studies · 12682 participants | High |
Clinical improvement: weaning or liberation from invasive mechanical ventilation in surviving patients, for subgroups of participants requiring invasive mechanical ventilationat baseline Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.04 [0.57, 1.93] | 2 studies · 630 participants | Low Downgraded: imprecision, inconsistency, indirectness, publication bias |
Clinical worsening: need for invasive mechanical ventilation,for subgroup of participants not requiring invasive mechanical ventilationat baseline Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.98 [0.89, 1.08] | 4 studies · 11765 participants | High |
Quality of life, including fatigue and neurological functioning; Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 309 participants | Very low Downgraded: imprecision, inconsistency, indirectness, publication bias |
Grade 3 and 4 adverse events ‐ total Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.9 [0.58, 1.41] | 4 studies · 905 participants | Low Downgraded: imprecision, inconsistency, indirectness, publication bias |
Serious adverse events ‐ total Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 1.24 [0.81, 1.9] | 2 studies · 414 participants | Low Downgraded: imprecision, inconsistency, indirectness, publication bias |
Summary of Findings Table ‐ Convalescent plasma compared to standard plasma for individuals with moderate to severe disease
Population: individuals with moderate to severe disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at up to day 28 Summary of Findings Table ‐ Convalescent plasma vs standard plasma | RR 0.95 [0.17, 5.29] | 2 studies · 252 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Clinical improvement, assessed by the need for respiratory support Summary of Findings Table ‐ Convalescent plasma vs standard plasma | no estimate extracted | 2 studies · 252 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Clinical worsening: need for invasive mechanical ventilation Summary of Findings Table ‐ Convalescent plasma vs standard plasma | RR 3.21 [0.38, 27.4] | 1 study · 29 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Quality of life, Summary of Findings Table ‐ Convalescent plasma vs standard plasma | no estimate extracted | 0 studies · 0 participants | Ungraded |
Grade 3 and 4 adverse events Summary of Findings Table ‐ Convalescent plasma vs standard plasma | no estimate extracted | 2 studies · 248 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Serious adverse events Summary of Findings Table ‐ Convalescent plasma vs standard plasma | RR 0.73 [0.49, 1.11] | 1 study · 219 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Summary of Findings Table ‐ Convalescent plasma compared to placebo or standard care alone for individuals with mild disease
Population: individuals with mild disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | RR 0.5 [0.09, 2.65] | 1 study · 160 participants | Very low Downgraded: imprecision, indirectness |
Development of severe clinical COVID‐19 symptoms Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 160 participants | Low Downgraded: imprecision, indirectness |
Quality of life, Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 0 studies · 0 participants | Ungraded |
Grade 3 and 4 adverse events Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 160 participants | Very low Downgraded: imprecision, indirectness |
Serious adverse events Summary of Findings Table ‐ Convalescent plasma vs placebo or standard care alone | no estimate extracted | 1 study · 160 participants | Very low Downgraded: imprecision, indirectness |
Convalescent plasma for people with COVID‐19
Population: people with COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes and study design | no estimate extracted | NR | No studies |
Randomised controlled trials | RR 0.55 [0.22, 1.34] | 1 study · 86 participants | Low Downgraded: risk of bias, imprecision |
Mortality (time to event) | no estimate extracted | NR | No studies |
Randomised controlled trials(up to 30 days) | HR 0.64 [0.33, 1.25] | 2 studies · 189 participants | Low Downgraded: risk of bias, imprecision |
Randomised controlled trials at day 7 | RR 0.98 [0.3, 3.19] | 1 study · 103 participants | Low Downgraded: imprecision |
Randomised controlled trialsat day 14 | RR 1.34 [0.85, 2.11] | 2 studies · 189 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Randomised controlled trialsat day 28 | RR 1.13 [0.88, 1.43] | 2 studies · 188 participants | Low Downgraded: risk of bias, imprecision |
Quality of Life | no estimate extracted | NR | No studies |
Controlled non‐randomised studies of interventions | no estimate extracted | NR | No studies |
Non‐controlled non‐randomised studies of interventions | OR 4 | 14 studies · 566 participants | Very low Downgraded: risk of bias |
Serious adverse events | no estimate extracted | NR | No studies |
Randomised controlled trials | no estimate extracted | NR | No studies |
Convalescent plasma for people with COVID‐19
Population: people with COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes and study design | no estimate extracted | NR | No studies |
Randomised controlled trials | no estimate extracted | 0 participants | Ungraded |
Controlled non‐randomised studies of interventions | RR 0.89 [0.61, 1.31] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Time to death | no estimate extracted | NR | No studies |
Randomised controlled trials( | HR 0.74 [0.3, 1.82] | 1 study · 103 participants | Very low Downgraded: risk of bias, imprecision |
Controlled non‐randomised studies of interventions ( | HR 0.46 | 1 study · 195 participants | Very low Downgraded: risk of bias, imprecision |
Randomised controlled trials at day 7Â | RR 0.98 [0.3, 3.19] | 1 study · 103 participants | Very low Downgraded: risk of bias, imprecision |
Randomised controlled trialsat day 14Â | RR 1.85 [0.91, 3.77] | 1 study · 103 participants | Very low Downgraded: risk of bias, imprecision |
Randomised controlled trialsat day 28Â | RR 1.2 [0.8, 1.81] | 1 study · 103 participants | Very low Downgraded: risk of bias, imprecision |
Quality of Life  | no estimate extracted | NR | No studies |
Randomised controlled trials | no estimate extracted | NR | No studies |
Non‐controlled non‐randomised studies of interventions | no estimate extracted | 13 studies · 201 participants | Very low Downgraded: risk of bias |
Serious adverse events | no estimate extracted | NR | No studies |
Controlled non‐randomised studies of interventions | no estimate extracted | NR | No studies |