Program and patient characteristics for the United States Expanded Access Program to COVID-19 convalescent plasma
Authors: Senefeld Jonathon W. , Johnson Patrick W. , Kunze Katie L. , van Helmond Noud , Klassen Stephen A. , Wiggins Chad C. , Bruno Katelyn A. , Golafshar Michael A. , Petersen Molly M. , Buras Matthew R. , Klompas Allan M. , Sexton Matthew A. , Soto Juan C. Diaz , Baker Sarah E. , Shepherd John R.A. , Verdun Nicole C. , Marks Peter , van Buskirk Camille M. , Winters Jeffrey L. , Stubbs James R. , Rea Robert F. , Herasevich Vitaly , Whelan Emily R. , Clayburn Andrew J. , Larson Kathryn F. , Ripoll Juan G. , Andersen Kylie J. , Vogt Matthew N.P. , Dennis Joshua J. , Regimbal Riley J. , Bauer Philippe R. , Blair Janis E. , Wright Katherine , Greenshields Joel T. , Paneth Nigel S. , Fairweather DeLisa , Wright R. Scott , Casadevall Arturo , Carter Rickey E. , Joyner Michael J. 
Published: April 2021

Background

The United States (US) Expanded Access Program (EAP) to COVID-19 convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease-2019 (COVID-19). While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents particularly for vulnerable racial and ethnic minority populations who were disproportionately affected by the pandemic. The objective of this study is to report on the demographic, geographic, and chronological access to COVID-19 convalescent plasma in the US via the EAP.

Methods and findings

Mayo Clinic served as the central IRB for all participating facilities and any US physician could participate as local physician–principal investigator. Registration occurred through the EAP central website. Blood banks rapidly developed logistics to provide convalescent plasma to hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal trends in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate on a state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions as well as assessing enrollment in metropolitan and less populated areas which did not have access to COVID-19 clinical trials.

From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. A majority of patients were older than 60 years of age (57.8%), male (58.4%), and overweight or obese (83.8%). There was substantial inclusion of minorities and underserved populations, including 46.4% of patients with a race other than White, and 37.2% of patients were of Hispanic ethnicity. Severe or life-threatening COVID-19 was present in 61.8% of patients and 18.9% of patients were mechanically ventilated at time of convalescent plasma infusion. Chronologically and geographically, increases in enrollment in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled patients in the EAP, including both in metropolitan and less populated areas.

Conclusions

The EAP successfully provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The efficient study design of the EAP may serve as an example framework for future efforts when broad access to a treatment is needed in response to a dynamic disease affecting demographic groups and areas historically underrepresented in clinical studies.