At home: After five days, the first patient treated with plasma therapy was removed from the ventilator

The main statements:

• The condition is improving among the first patients to receive plasma therapy at home.
• One of them could have been removed from the ventilator five days after treatment.
• The experimental plasma-based treatment of patients recovering from Covid-19 disease is currently used in more severe patients.
• Other innovative pharmacological treatments are also being used in the hospital and good results are being achieved.
• Both are very important because there is still no vaccine or therapy developed specifically for the disease.
• Therapy alone is effective only in a subset of patients.

hvg.hu: What is the condition of your patients treated with plasma therapy?

István Vályi-Nagy: The two patients treated so far are in the intensive care unit at the moment. One of them recovered, was removed from the fan; they both needed ventilation temporarily. The other older patient is also fine, also waking up slowly from deep anesthesia.

Our experience to date has shown that the breathing period is significantly shortened in both plasma-treated patients and those receiving innovative drug therapy.

hvg.hu: When did you start your plasma treatment?

NEITHER:. V The first patient to have severe comorbidity, chronic kidney disease, received treatment in installments last Friday and Saturday. He was successfully removed from the plane after five days. The other patient received plasma therapy a few days ago, stabilized and improved. She was in a more serious condition because she was old.

hvg.hu: Are other similar treatments planned?

NEITHER:. V Yes. We started this therapy in the country for the first time, we obtained the permits for it, but it should be noted that it is an experimental therapy worldwide. However, the treatment is not complicated, the most important thing is the safe production of plasma. From the collected plasma, the National Blood Service prepares an official blood product and this is administered. We have some of our own donors among our healed patients, and the other national institute, the National Institute of Pneumology, also has many patients who, after recovery, are asked to be long-term donors. Of course, we wait with them for 2-3 weeks and only then do we call them for the plasma donation.

hvg.hu: Does being a long-term donor mean that you can take plasma more than once?

NEITHER:. V Yes, those who have a good immune response can take plasma 2-3 times as long as they voluntarily undergo the procedure.

hvg.hu: Does plasma donation pose a risk to donors?

NEITHER:. V The risk is less than that of blood donation, since the formal elements of the blood are not eliminated, only the plasma and the volume taken are replaced. There is practically no risk, it is done with special machines, with great security, routinely.

hvg.hu: Are all healed people invited to donors or are they tested in some way?

NEITHER:. V We routinely ask those who are between 18 and 60 years old, but we go up to 70 for those who do not have comorbidities and are in good general condition. It is also important that the national medical director has a database of those recovered and has already sent letters to more than 300 potential donors indicating to which phone number and email address to request a donor.

Donors are welcome

The National Institute of Hematology and Infectology at South Pest Central Hospital is waiting for patients with coronavirus to request administration of blood plasma: Telephone: 06 30 602 9250 | E-mail: [email protected] | Online: www.koronavirusplazma.hu

hvg.hu: Approximately what percentage of the respondents are donors?

NEITHER:. V I wouldn’t say an exact number, but they appear in abundance. It is important to note that not everyone is suitable as a donor. Especially in young and mildly symptomatic patients, it is observed that they do not have an adequate immune response. A stronger immune response is more common in more severe patients.

hvg.hu: When I spoke to Dr. Zsombor Lacza, the vice chancellor for science at the University of Physical Education, the research leader at OrthoSera Kft., who is also organizing similar treatments, a few days ago, said that you risk getting the infection again. of the virus. Do you see it like that?

NEITHER:. V In theory, this is the case, but we still don’t know for sure. This is speculation that may have a basis, but I have yet to see a document or research that certainly supports it.

hvg.hu: Based on what decision is made which patient will receive plasma therapy?

NEITHER:. V For the time being, Hungary has managed to avoid a massive epidemic.

In the current state of the epidemic, we still maintain that there are relatively few patients and relatively few donors, and that the appropriate therapeutic situation needs to be found for treatment.

At the moment, we only use plasma therapy in patients with severe and critical conditions, and it is a basic requirement that the blood group of the donor and the patient coincide. Another important consideration is that only plasmas with the appropriate antibody levels are suitable for administration. By organizing these factors together, we select those for whom this therapy is used. So far, only those in the intensive care unit have received plasma from us, but of course we strive to do so in as many patients as possible. Later, we plan to include less severe patients in the experimental treatment.

hvg.hu: What is the reason why it is now only used in critically ill patients?

NEITHER:. V Because they need it more, and I think that treating patients in better clinical conditions can be done without plasma. Western countries affected by the massive epidemic have launched central plasma collection programs. Where there are more patients and more donors, there is obviously a greater number of such interventions. These, of course, have the same essence, proper donor screening, substance disposal, provision of safe conditions, and donor-patient matching according to an international standard.

Plasma collection from recovered patients in Hungary was one of the first in the world.

hvg.hu: How could the range of potential donors be expanded? Would it be a viable way, for example, to recruit from those who do not have a document that they were sick, but perhaps they themselves suspect that they have already passed it?

NEITHER:. V There are many of them. We do not choose from this point of view, for us the suitability of the donor is paramount. The important thing is not the role, but the person who administers the plasma is no longer infectious and has adequate levels of antibodies.

hvg.hu: How long can donors donate usable plasma?

NEITHER:. V The immune substances we are looking for appear approximately 2-3 weeks after infection, not earlier than two weeks, but rather three weeks. It is also the subject of worldwide research on how long immunoglobulin blood levels are maintained in those with an adequate immune response. There is increasing evidence that a viral infection does not cause permanent immunity in many, but it will go away or decrease in a few months. This, of course, also affects the problem of active immunization, that is, vaccination. Because even if you get a vaccine, you will need to measure how long it lasts and the quality of immunity it creates.

hvg.hu: Speaking of vaccines: There are many statements and news about when vaccines are expected. One of his colleagues, János Slavik, for example, recently said at an operational tribe briefing that the vaccine could be available in the fall, but on Thursday a WHO staff member said this was expected next year at the earliest. soon. How do you see this

NEITHER:. V Everyone speculates on this. If only because companies work in great secrecy. To my knowledge, at least 70 different sites and different technologies are being tested for vaccination, of which 4-5 are at an advanced stage, but not even at a stage where we know they will be good or not.

hvg.hu: To what extent can plasma therapy be adequate to stop the epidemic or cure patients in large numbers?

NEITHER:. V In developed countries, so-called randomized trials have been launched to compare the recovery data of patients receiving and receiving plasma. These surveys will have some preliminary results in late May or June at the earliest, where data on the efficacy of treatment for large numbers of patients will be publicly analyzable. Fortunately, we have a much smaller number of serious patients. To help them, we had to start the treatments before evaluating our experience abroad. We advance based on our own experience.

Because there is no specific vaccine or therapy, we help patients as best we can. Regarding plasma treatment and the innovative drug therapies we use, I can say that we have good experiences and are optimistic.

hvg.hu: It has been a relatively long time since the epidemic appeared in Hungary, and you also have a relatively large amount of experience. How has the way they view the epidemic and disease changed?

NEITHER:. V I am not an epidemiologist. It is obvious that in the event of an epidemic threat, one should always prepare for the worst case scenario. There are different models for the course of the epidemic, people assume that the bad scenario will happen, there will be many more sick people and many more people who need a fan in the country, but that has not happened yet. It turned out that the model developed by the health industry and not by mathematicians is the closest to reality. From now on, as the Medical Director announced, the decline phase of the first wave of the epidemic appears to be beginning. Obviously, many factors have contributed to this favorable change. The epidemic was basically handled well, the population was relatively disciplined relative to the entire country, the climate was warming (epidemiologists hope the virus is more manageable) an ed.), we doctors also have a better command of the treatment of patients, which in addition to plasma therapy is the so-called. cytokine storm medication (i.e., severe inflammation).

hvg.hu: What does this mean?

NEITHER:. V Some patients develop a condition characterized by a so-called cytokine storm. It is an abnormally intensified immune inflammatory process, which means severe and fatal pneumonia and respiratory failure, damage to the heart, kidneys, disorders of the blood clotting system and even the development of symptoms of the central nervous system. South Pest Central Hospital is also the national medical institution for infectious and hematopoietic system diseases. Cytokine storm is a common complication of certain forms of allogeneic bone marrow transplantation and many serious viral infections. We treat dozens of such patients each year, so we recognize the early process in patients with severe and critical coronaviruses. At this stage, it is no longer the treatment of the infection, but the ability to significantly intervene in the complex pathological process that causes, even death, that is crucial to the outcome of the disease. In such cases, innovative medication and treatment in intensive care units can save lives, where plasma treatment can be part of the protocol.

hvg.hu: What methods and drugs are used for this?

NEITHER:. V In such severe inflammations, a molecule called interleukin-6 is released, along with other inflammatory molecules, of course, but interleukin-6 is a central player in the process, and we are constantly monitoring its levels and adjusting our treatment accordingly. In doing so, we use so-called commercially available monoclonal antibody drugs, one of which is tocilizumab, and we have a lot of experience with this. The drug was also one of the first in the world to be used to treat a cytokine storm caused by a coronavirus.

hvg.hu: And how did your experience with Covid-19 develop from a medical point of view? For example, who develops a serious condition?

NEITHER:. V The subject of intensive research, which we have started, is who will make serious patients. There are assumptions that this would be a genetic trait. It is also possible that there are serious patients whose immune response is only partially adequate and who cannot eliminate the virus from their body. And, obviously, there will be serious patients who have comorbidity: A chronic lung patient is less likely to have such a serious condition, but high blood pressure, diabetes, and chronic kidney disease are among the factors that exacerbate the condition.

hvg.hu: Currently, plasma therapy is carried out by two groups in Hungary: you and Orthosera Kft., who work with the Semmelweis University and virologists at the University of Pécs. Do you have cooperation?

NEITHER:. V Sometimes we exchange ideas and supervise the activities of others, but we are so burdened with patient care that our own consortium, that is, outside our hospital, the National Center for Public Health, OVSZ and some partner institutions, is not yet working with others. On the other hand, it is very good that there are two initiatives of this type, which are in the initial and experimental phase, but which will eventually unite. Importantly, the treatment of critically ill and critically ill patients with complex mechanisms is multifaceted and complex. Optimism about plasma therapy is warranted, but when administered only effective in only a subset of patients.

Patients in very poor condition definitely require a complex therapeutic approach (eg plasma, medication and intensive). This also suggests that determining the exact location of plasma treatment remains a task for the future. Fortunately, asymptomatic and mildly symptomatic patients recover on their own anyway, and do not need drug or plasma therapy.

Which bears the image: A woman donates blood plasma at the Biotest plasmapheresis station in Budapest on April 28, 2020