COVID-19 in Mumbai: Few takers for plasma therapy

Many city hospitals have not been using it; civic officials feel that most private hospitals dont opt for it since it is a low-cost option

Despite two ongoing clinical trials on the use of plasma therapy for COVID-19 patients and the recent regulations allowing off-label (outside clinical trials) use of convalescent plasma for emergency cases, it is not a popular option in city hospitals. While doctors described challenges like lack of availability of viable plasma and the need for more clarity on treatment protocol, civic officials feel that most private hospitals don't opt for plasma therapy as it is low-cost.

The two ongoing clinical trials on plasma therapy include the PLACID trial started by the ICMR and the state's Project Platina. Given the growing number of COVID-related deaths in the state, on June 29, the Directorate of Medical Education and Research (DMER) allowed off-label use of plasma therapy to patients with moderate symptoms but not responding to medication. While no approvals are needed for off-label use, private hospitals opting for it have to inform the state government and the Drug Controller General of India.

Few applications for use
Sources in DMER said in the state, only 25-30 applications have been submitted for off-label use. While hospitals like Saifee, Bhatia, Global and Fortis haven't used plasma therapy, hospitals like Hinduja, Jaslok, Reliance and Nanavati did not wish to comment.

Dr Behram Pardiwala, principal investigator of the plasma trial at Wockhardt Hospital said, "Certain patients didn't meet the criteria and we gave two of them plasma on compassionate grounds. Both have now recovered. Patients who are a little breathless and their oxygen saturation is dropping could benefit from plasma therapy."

Lilavati Hospital gave plasma therapy to three patients and while one died, the other two recovered. Dr Jalil Parkar, pulmonologist at Lilavati Hospital, said, "Plasma therapy varies from patient to patient. We have to consider how quickly the patient's condition is deteriorating and his co-morbidities as well," he said.

Civic body will help
Additional Municipal Commissioner Suresh Kakani said that in civic hospitals, more than 25 patients were given plasma therapy, of which one died. "As plasma is a donation, there are no high charges and private hospitals are not getting anything out of it. Government hospitals have a huge number of discharged patients and we can give private hospitals their contact details. We are ready to help in any way we can," he said.

Dr Kedar Toraskar, a member of the COVID task force, added that meeting the eligibility criteria is an issue due to which many are not able to donate plasma. "As per the ICMR trial, a recovered patient has to have a high titer (antibodies in the blood) to be eligible to donate plasma. Many blood bank officers in Mumbai I spoke to said that the titer of our patients is not that high, due to which getting the plasma that meets the criteria is difficult," he said.

But the limited availability of plasma affects government hospitals as well. Nair Hospital dean, Dr Mohan Joshi said, "We contact around 50 patients every day of which only 10 per cent come. So around four people are screened of whom 1-2 can donate based on the criteria."

29 June
When DMER allowed off-label use of plasma therapy

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