Mumbai: Doctors for early use of plasma though first trial shows no big dip in deaths

MUMBAI: Use of convalescent plasma therapy that has grown in city hospitals is unlikely to slow down despite the country’s first clinical trial showing no significant decline in mortality numbers or progression to severe Covid-19. City doctors are of the opinion that plasma has a role to play in patient care when administered during the right treatment window.
Indian Council of Medical Research (ICMR), which carried out the country’s first multicentre, randomized controlled trial with 464 participants across 39 public and private hospitals, revealed the mortality of 13.6% in those who received plasma was not significantly lower than those who didn’t (14.6%). Use of plasma as an investigational therapy was allowed by the drug regulatory body on June
13. It’s only in the past month and half, though, that banks have got more donors and hospitals have started its frequent use.
Dr Om Srivastava, one of the principal investigators from Kasturba Hospital in the ICMR trial, said the take-home message was that timing is crucial. “If used in right patients, plasma still works,” he said, adding the therapy shouldn’t be junked just because it doesn’t reduce mortality. “We probably shouldn’t wait till a patient is too sick or already moderately ill. It could work in an earlier stage in highrisk patients,” he added. Dr Kusum Jashnani, head of pathology at B Y L Nair Hospital, another trial site, said, “Our clinicians have found out that once a patient has gone into cytokine storm, it doesn’t help much in arresting the deterioration.”
Dr Rahul Pandit, ICU head at Fortis Hospital and a member of the state task force, concurred that plasma may not work on the ninth day of the illness but it could work well when administered on the fifth or sixth day. Intensivist Dr Abdul Ansari from Nanavati Hospital, where several patients have received plasma, said the trial findings show why clinicians cannot afford to go gung-ho over any one therapy. “We believe it works in combination but it’s surely not a magic pill,” he said.
State officials said the ICMR findings would have no bearing on Maharashtra’s PLATINA trial that is studying whether it helps critical Covid patients unlike the ICMR trial that studied moderate cases. “We will go ahead as planned,” a state official said, adding the trial has taken off in several centres now.
Dr Pandit summed up that six months into the epidemic it’s now recognized that “good old care” works best in the ICU. “For instance, ventilatory management of a patient with acute respiratory disorder syndrome works best,” said Dr Pandit.
Dr Shashank Joshi, another member of the state task force, said, “We know a Covid patient benefits from early oxygen supply, lying in prone position and intake of steroids if on ventilator support,” he said.