Why did ICMR drops Plasma Therapy for COVID-19 treatment

Pandemic May 28, 2021

The discussions and debates on convalescent plasma therapy have increased exponentially on numerous social media platforms amidst the pandemonium of the second wave of the COVID-19 pandemic.

Convalescent Plasma Therapy (CPT)

CPT had been one of the most popular ‘treatments’ for COVID-19 in the early months of the pandemic as it was thought to be an effective tool in the prevention of the progression of the disease from moderate to critical condition. This method was allowed ‘off label’ by the COVID-19 treatment protocol which was formulated in consultation with the Indian Council of Medical Research (ICMR), AIIMS, New Delhi and others.

Under CPT, a COVID-19 patient is injected with convalescent sera of those individuals who had recently recovered from the infection. The serum of the cured COVID-19 person has virus-neutralising antibodies that act as a passive antibody therapy which will in turn exterminate the Coronavirus.

Studies

A study published in the British Medical Journal in November 2020 found that CPT was ineffective in the reduction or containment of the severity of infection. The study was conducted in 39 private and public hospitals throughout India that involved 464 adults who were admitted between April and July 2020.

The Lancet carried a study published titled ‘Convalescent plasma in patients hospitalised with COVID-19’ on 14th May, 2021. This study reiterated the findings of the 2020 study. The double blinded trial involving around 5,000 patients who had received COVID-19 treatment in the United Kingdom found no noteworthy benefit of using plasma.

Removal of CPT

On 14th May, 2021, members of the ICMR-National Covid-19 Task Force, expressed their unanimous agreement for the removal of CPT from the Clinical Guidance for Management of Adult COVID-19 Patients (CGMACP) based on its ineffectiveness and improper use in many cases. Subsequently, on 17th May, a Government-appointed Task Force removed CPT from the treatment protocol for COVID-19 patients.

Backdrop of the ICMR decision

A few concerned clinicians, public health professionals and scientists wrote to the Principal Scientific Advisor K. VijayRaghavan; ICMR Chief, Dr. Balram Bhargava and AIIMS Director, Dr. Randeep Guleria about the “irrational and non-scientific use” of the CPT. This letter that pointed out that the CPT did not have a sturdy scientific foundation and the possible association between the surfacing of variants and the lower susceptibility to neutralising antibodies in immunosuppressed individuals who are given plasma therapy, formed the backdrop of the ICMR decision to withdraw CPT from the treatment protocol.

The current ICMR guidelines recommend Ivermectin and Hydroxychloroquine for mild disease but also underline the caveat that both drugs have “low certainty of evidence.”

Conclusion

Despite the lack of evidence about the effectiveness of CPT, many doctors have frequently recommended its use. This has put undue stress on caregivers to source the required plasma from recovered patients. Due to the shortage of supplies and the increasing cases, many have resorted to acquiring the plasma through illegal sources.

Through careful awareness programmes, the Government as well as the healthcare professionals will be able to make citizens aware of the right treatment method and also put a stop to the COVID-19 blackmarkets.

This article has been written by Ruchira Sarma for The Paradigm.

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