National CCP Project Investigators Urge WHO to Reconsider CCP in COVID-19 Drugs Guideline

A group of investigators from the National Covid-19 Convalescent Plasma Project urged the World Health Organization (WHO) to reconsider its December 2021 recommendation against the use of COVID-19 convalescent plasma (CCP) in patients with critical, severe or non-severe illness. The recommendation is part of the living WHO guideline on drugs for COVID-19.

A WHO Guideline Development Group of international experts based its recommendation on evidence from 16 randomized clinical trials (RCTs) involving 16,236 patients with non-severe, severe and critical illness. The Development Group noted, however, that “sufficient uncertainty” in patients with severe and critical illness warrants the continuation of RCTs.

In a response published in the BMJ on Feb. 8, investigators from the National CCP Project stated that the WHO summary avoided questions about treatment timing, study populations and the antibody titer of the administered CCP in the reviewed RCTs. They also noted that the WHO recommendations may discourage CCP use in low- and middle-income countries, where CCP is the only antiviral intervention available.

“We urge WHO to revisit its recommendation by reviewing the totality and consistency of the evidence supporting benefit, taking into account the pandemic conditions and RCT design features that affected the findings from most large RCTs,” the authors wrote.