India drops plasma therapy from COVID-19 management guidelines

The Indian government on Monday revised the clinical guidance for COVID-19 treatment, dropping the off-label use of convalescent plasma as it was found not beneficial in reducing the progression to severe disease or death.

The development came following a meeting of the ICMR-National Task Force for COVID-19 last week, wherein all members were in favour of removing the use of convalescent plasma from the guidelines, citing its ineffectiveness and inappropriate use in several cases.

An Indian Council of Medical Research (ICMR) official said the task force "revised" the Clinical Guidance for Management of Adult COVID-19 Patients and "dropped convalescent plasma (off label)".

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The previous guidelines recommended off-label use of plasma therapy at the stage of early moderate disease, that is, within seven days of the onset of symptoms and if there is the availability of a high titre donor plasma.

The decision to remove it from the guidelines comes in the backdrop of some clinicians and scientists writing to Principal Scientific Advisor K VijayRaghavan, cautioning against the "irrational and non-scientific use" of convalescent plasma for COVID-19 in the country.

In the letter — which was also marked to ICMR Chief Balram Bhargava and AIIMS Director Randeep Guleria — public health professionals alleged that "the current guidelines on plasma therapy are not based on existing evidence, and pointed out some very early evidence that indicates a possible association between emergence of variants with lower susceptibility to neutralising antibodies in immunosuppressed" people given plasma therapy.

This raises the possibility of more virulent strains developing due to irrational use of plasma therapy, which can fuel the pandemic, according to the letter signed by vaccinologist Gagandeep Kang, surgeon Pramesh C S, and others.

"We are writing to you as concerned clinicians, public health professionals, and scientists from India about the irrational and non-scientific use of convalescent plasma for COVID-19 in the country.

"This has stemmed from guidelines issued by government agencies, and we request your urgent intervention to address the issue, which can prevent harassment of COVID-19 patients, their families, their clinicians, and COVID-19 survivors, said the letter.

"The current research evidence unanimously indicates that there is no benefit offered by convalescent plasma for treatment of COVID-19. However, it continues to be prescribed rampantly in hospitals across India, the letter said.