New Delhi: Days after Indian Council of Medical Research (ICMR) Director General Dr Balram Bhargava said India is planning to remove plasma therapy from the list of Covid treatment options, the council has issued a fresh advisory on the need to transfuse plasma at the correct time, and after relevant checks.
Spurred by Home Minister Amit Shah’s intervention at a review meeting last week, the joint working group of the Ministry of Health headed by the director general of health services is also working on a similar document.
The ICMR has highlighted the need to check for neutralising antibodies in the plasma and also underscored the fact that it works early on in the disease before the patient’s own immune system has kickstarted.
“It is speculated that convalescent plasma having low concentration of specific antibody against SARS-CoV-2 may be less beneficial for treating COVID-19 patients as compared to plasma with high concentration of such antibodies. This advisory therefore embraces the principle that a potential donor for convalescent plasma should have sufficient concentration of antibody working against COVID-19 as narrated in the matrix below,” reads the advisory issued late on Wednesday night.
The advisory also “highlights that presence of antibody against COVID-19 in a potential recipient makes transfusing convalescent plasma a futile intervention”.
Earlier, ICMR DG and Secretary, Health Research, Bhargava had said the government is in the process of removing plasma therapy from the list of therapies for Covid after an ICMR trial returned a negative.
His comments were based on the ICMR’s PLACID trial that, however, did not check for neutralising antibodies as the technology was then not available in India.
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Indiscriminate use is no good, advisory says
On the PLACID trial, the advisory says: “ICMR conducted an open label phase II multicentre randomised controlled trial in India across 39 public and private hospitals on use of convalescent plasma in the management of cases with moderate COVID-19 disease (PLACID Trial). It was concluded that, CPT DID NOT LEAD TO REDUCTION IN PROGRESSION TO SEVERE COVID-19 OR ALL-CAUSE MORTALITY in the group that received CPT as compared to the group that did not receive CPT4.”
It explains: “PLACID is the WORLD’S LARGEST PRAGMATIC TRIAL on CPT conducted in 464 moderately ill laboratory confirmed COVID-19 affected adults in real world setting wherein no benefit of use of CPT could be established. Similar studies conducted in China and Netherlands have also documented no significant benefit of CPT in improving the clinical outcomes of hospitalised COVID-19 patients.”
The advisory goes on to add that indiscriminate use of the therapy is not advisable and specifies the minimum neutralising antibody concentration in plasma that is necessary before transfusion.
A virus or a bacteria in the body can generate different kinds of antibodies, which fight off the infection, depending on which antigen has triggered their production. Antibodies against the SARS-CoV2, for example, can be either against its nuclear protein or against the spike protein. It is only the latter that have a protective effect, and are known as neutralising antibodies.
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