Experts denounce scrapping of plasma therapy

Several experts have denounced the move to scrap plasma therapy as a recommended treatment for Covid-19 which will adversely affect patient recoveries

Experts have denounced the Centre’s move to scrap plasma therapy as a recommended treatment for Covid-19 as a misstep which will adversely affect patient recoveries.

“Not only will this limit a promising, off-label therapy but it will push it further into the black market,” one expert cautioned, adding that desperate patients and families will continue to demand plasma.

State nodal officer for plasma testing Dr D Jayaraju, deputy director of Blood Services, KSAPS, confirmed that all convalescent plasma therapy-related activities will cease in government hospitals.

The announcement that the therapy would be scrapped was made on the basis of an open-label, parallel-arm randomised controlled trial, called PLACID, conducted by the Indian Council of Medical Research (ICMR) which concluded that “convalescent plasma was not associated with a reduction in mortality or progression to severe Covid-19.”

However, there is growing scepticism over the ICMR study as it did not check for the presence of neutralising antibodies in plasma being transfused into patients. “Giving plasma without antibodies is like administering saline which has no positive effects whatsoever,” said Dr U S Vishal Rao of HCG Hospitals, who helped kickstart the plasma therapy programme in Karnataka.

On page 23 of the study, the ICMR itself admits that reliable tests to gauge neutralising antibodies in a plasma sample were not available in India when the study was launched (on April 22).

Big mistake

Dr Rao said he has strongly denounced in writing the Centre’s decision to pull the plug on “the only science” which works on Covid-19. He admitted that there was a need for scrutiny on what type of antibodies and what dosages need to be given to patients. “These are answers which are emerging but in the interim, the Centre must continue to offer plasma therapies,” he
said.

Dr R Sreelatha, head of the Transfusion Medicine Department in Victoria Hospital, one the first entities in the state to conduct convalescent plasma trials, said unequivocally that the therapy works. “The time-frame of administration is important. It is most efficacious when oxygen saturation is not yet below 92%,” she said.

Another authoritative expert who did not want to be named heaped further scepticism on the study, saying its conclusions cannot be trusted.

Dr Rao pointed to the fact that the study had failed to note the percentage of NAb (neutralising antibody) titers, whether they were high, moderate or low.

A titer is a laboratory test that measures the presence and amount of antibodies in the blood.

“Optimum titers play a pivotal role in the success of plasma therapy. The study does not mention percentages,” Dr Rao said.

He also pointed to a recent study of 42 Indian Covid-19 patients by Emory University in the United States. Researchers discovered that while 90.47% of patients had developed an IgG response, only half of them had appreciable Covid-neutralizing antibody titers.