Recovery of severely ill COVID-19 patients by intravenous immunoglobulin (IVIG) treatment: A case series

Mohtadi, Negar; Ghaysouri, Abas; Shirazi, Samira; Ansari, Sara; Shafiee, Elham; Bastani, Elham; Kokhazadeh, Taleb; Tabesh, Hamed

doi:10.1016/j.virol.2020.05.006

Cited by 66 publications

(79 citation statements)

References 8 publications

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“…These main results are in line with case reports describing recovery of deteriorating severely ill patients suffering from COVID-19 after initiation of IVIG treatment [7][8][9][10][11] and a small prospective open-label randomized clinical trial in the US showing in a patient subgroup with an alveolar-arterial gradient of >200 mm Hg at enrollment a lower rate of progression to mechanical ventilation requirement, shorter hospital and ICU stay and greater improvement in PaO2/FiO2 at 7 days when treated with the combination of IVIG and SOC than with SOC alone [16]. Our study also con rmed results of two retrospective cohort studies in China [12,13], one of which demonstrated IVIG to signi cantly reduce 28day mortality, to decrease in ammatory response, and to improve some organ functions in a subgroup of 103 critically ill patients only.…”

Section: Discussionsupporting

confidence: 91%

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Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Esen¹,

Özcan²,

Orhun³

et al. 2020

Preprint

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Background: There is some evidence from case reports and a few studies in China that critically ill COVID-19 patients may benefit from treatment with intravenous immunoglobulins (IVIG). We compared clinical outcomes and biomarkers in a Turkish cohort of patients with severe COVID-19 who were treated with the institution's standard of care (SOC), either alone or in combination with IVIG.Methods: Data from COVID-19 patients treated in two intensive care units at the University hospital of Istanbul was analyzed retrospectively. Patients received preliminary SOC according to the institution's treatment algorithm, to which Octagam 5% at 30 g/day for 5 days was added in one of the two wards. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers (C-reactive protein=CRP, ferritin, procalcitonin, interleukin-6, D‑dimer, leukocytes). Imbalance in baseline APACHE II scores was addressed by propensity-score-matching; otherwise Kaplan-Meier and multiple logistic regression models were used.Results: Data from 93 patients was analyzed, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index (BMI) and blood group distribution. IVIG-treated patients were younger (means 65 vs. 71 years) and had slightly lower baseline disease scores (APACHE II: 20.6 vs. 22.4; SOFA: 5.0 vs. 7.0). Overall survival (OS) was 61% in the IVIG and 38% in the control group. After controlling for imbalances at baseline, there was still a trend for better OS (OR: 2.2, 95%CI: 0.9-5.4, p=0.091) and a significantly longer median survival time with IVIG (68 vs. 18 days, p=0.014). IVIG significantly reduced CRP levels, but had no relevant effect on other inflammation markers.Conclusion: Adjunct treatment with IVIG might add to the COVID-19 armamentarium, but results need to be confirmed in a randomized, controlled trial.

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Section: Discussionsupporting

confidence: 91%

“…Recently, two marketed IVIG products were shown to react with SARS-CoV 2 antigens in vitro [6]. In line with all this, there have been case reports of COVID-19 patients who bene ted from IVIG treatment [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 83%

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Esen¹,

Özcan²,

Orhun³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition, commercially available IVIG preparations contain antibodies cross-reactive to SARS CoV-2 or endogenous proteins, such as cytokines ( 156 ). Therefore, IVIG have been used in COVID-19 ( 157 – 159 ). However, as no case-control studies or RCT's have been published so far, the therapeutic efficacy of IVIG in COVID-19 is unknown.…”

Section: Should We Use Dmards For the Therapy Of Covid-19?mentioning

confidence: 99%

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

et al. 2020

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In December 2019, a cluster of severe pneumonia was observed in China, with the subsequent discovery of a new beta-coronavirus (SARS-CoV-2) as the causative agent. The elicited disease COVID-19 is characterized by fever, dry cough, myalgia, or fatigue and has a favorable outcome in the majority of cases. However, in some patients COVID-19 leads to severe pneumonia and sepsis with subsequent respiratory failure and gastrointestinal, hematological, neurological, and cardiovascular complications. A higher risk of infection is intrinsic to active rheumatic and musculoskeletal diseases (RMD) and the use of biological disease modifying anti-rheumatic drugs (DMARDs). With an increasing number of reports on COVID-19 in RMD patients, we are beginning to appraise their risks. In this review, we summarize the published cases of COVID-19 infections in RMD patients, including patients with inflammatory arthritis and connective tissue diseases as well as anti-phospholipid syndrome and Kawasaki syndrome. Overall, patients with inflammatory arthritis do not seem to be at a higher risk for infection or a severe course of COVID-19. Risk for critical COVID-19 in patients with systemic inflammatory diseases such as SLE or vasculitis might be increased, but this needs further confirmation. Furthermore, we summarize the data on DMARDs used to fight SARS-CoV-2 infection and hyperinflammation.

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“…Currently, data are available from seven reports including the multicentre study of Shao et al that explored IVIG immunotherapy in the management of COVID-19 (Table 1). [5][6][7][8][9][10][11] These studies are mostly case series or retrospective, with an exception of one study that was randomised open-label trial. Although retrospective, data from Shao et al included large number of COVID-19 patients compared to other studies, and hence, data are more reliable.…”

Section: Ivig Immunotherapy For the Treatment Of Covid-19mentioning

confidence: 99%

Intravenous immunoglobulin immunotherapy for coronavirus disease‐19 (COVID‐19)

2020

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Intravenous immunoglobulin (IVIG), a pooled normal IgG from several thousand healthy donors and one of the commonly used immunotherapeutic molecules for the management of autoimmune and inflammatory diseases, has been explored for the treatment of coronavirus disease‐19 (COVID‐19). Although placebo‐controlled, double‐blind randomised clinical trials are lacking, current data from either retrospective, case series or open‐label randomised controlled trials provide an indicator that IVIG immunotherapy could benefit severe and critically ill COVID‐19 patients. See alsoShao et al.

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Recovery of severely ill COVID-19 patients by intravenous immunoglobulin (IVIG) treatment: A case series

Cited by 66 publications

References 8 publications

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Intravenous immunoglobulin immunotherapy for coronavirus disease‐19 (COVID‐19)

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