Letters to the Editor
- Convalescent plasma (CP) therapy uses neutralizing antibodies harvested from recovered patients to treat viral infections, including severe acute respiratory syndrome coronavirus (SARS-CoV) and influenza A.1 The emerging data from randomized controlled trials and observational studies suggest—consistent with historical precedent—that CP therapy has limited efficacy in severely ill patients with coronavirus disease 2019 (COVID-19) treated late in the disease course. However, early treatment with high-titer CP exhibits signs of efficacy.
- Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) remains a widely used therapeutic option for patients hospitalized for COVID-19 as further variant strains continue to arise. We recently reported significantly elevated positivity rates (P < .0001) for HLA antibodies (HLA-Abs), a risk factor for transfusion-associated acute lung injury, in 5 of 69 local male CCP donors (7.2 %).1,2 As noted in a subsequent reply letter though, CCP has repeatedly exhibited a safety profile similar to standard plasma.
- We would like to thank Franchini and Cruciani for their letter in response to our systematic review and meta-analysis studying the effect of convalescent plasma therapy on the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19).1 This letter highlights important new meta-analytical data based on 30 controlled studies (including 14 randomized clinical trials) demonstrating that convalescent plasma transfusion does not increase the risk of adverse events, including thromboembolic events, compared with patients diagnosed with COVID-19 who either were not transfused or were transfused with standard fresh frozen plasma.
- We would like to thank our colleagues for their letter in response to our manuscript. The letter raises important theoretical concerns about the impact of procoagulant factors in plasma on the coagulation cascade in the context of patients with severe COVID-19.1 Generally, we agree with the word of caution regarding the use of convalescent plasma in the context of patients with severe COVID-19 and evidence of dysregulated hemostasis, as observed among patients who required extracorporeal membrane oxygenation (ECMO) support.
- The authors thank Dr Farag for his letter in response to our manuscript “Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients.”1 The letter raises important questions about the presentation of our updated safety report from the Convalescent Plasma Expanded Access Program (EAP). The fundamental element of our response to all of the questions raised by Dr Farag is the need to frame the context of the paper. Establishing clinical efficacy for a potential therapeutic agent deployed during a public health crisis involves a climb through an epistemic ladder, and the comments from Dr Farag primarily highlight future rungs of that ladder.
- To the Editor: Statins are among the most commonly prescribed medications in the world. Myalgia is frequently reported in up to 25% of users,1 and more serious adverse effects on muscle such as rhabdomyolysis are seen in 0.04% to 0.2% of users.1 Muscle rupture has also been reported.2 Furthermore, subgroups such as professional athletes appear to be especially intolerant to statin drugs.3 Dietary interventions such as the portfolio diet have also been reported to cause marked reductions in cholesterol.