What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness

Miller, Andrew C.; Ghadermarzi, Shadi; Venkatachalam, Shobi

doi:10.4103/ijciis.ijciis_26_21

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…The exploration of passive immunization as treatment modality for COVID-19 patients has been limited to the use of convalescent plasma [14,15] and SARS-CoV-2 neutralizing monoclonal antibody preparations to date [16,17]. Many systematic reviews, meta-analysis and clinical studies [18][19][20] had discussed and looked forward to reports on usage of hyperimmune antibody drugs for treatment of COVID-19 patients. C-IVIG showed a relative risk reduction in the 28day mortality rate in all intervention arms as compared to the control group, however statistically insignificant.…”

Section: Discussionmentioning

confidence: 99%

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial

Ali¹,

Uddin²,

Shalim³

et al. 2021

EClinicalMedicine

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Background: Hyperimmune anti-COVID-19 Intravenous Immunoglobulin (C-IVIG) is an unexplored therapy amidst the rapidly evolving spectrum of medical therapies for COVID-19 and is expected to counter the three most lifethreatening consequences of COVID-19 including lung injury by the virus, cytokine storm and sepsis. Methods: A single center, phase I/II, randomized controlled, single-blinded trial was conducted at Dow University of Health Sciences, Karachi, Pakistan. Participants were COVID-19 infected individuals, classified as either severely or critically ill with Acute Respiratory Distress Syndrome (ARDS). Participants were randomized through parallel-group design with sequential assignment in a 4:1 allocation to either intervention group with four C-IVIG dosage arms (0.15, 0.20, 0.25, 0.30 g/kg), or control group receiving standard of care only (n = 10). Primary outcomes were 28-day mortality, patient's clinical status on ordinal scale and Horowitz index (HI), and were analysed in all randomized participants that completed the follow-up period (intentionto-treat population). The trial was registered at clinicaltrials.gov (NCT04521309). Findings: Fifty participants were enrolled in the study from June 19, 2020 to February 3, 2021 with a mean age of 56.54 §13.2 years of which 22 patients (44%) had severe and 28 patients (56%) had critical COVID-19. Mortality occurred in ten of 40 participants (25%) in intervention group compared to six of ten (60%) in control group, with relative risk reduction in intervention arm I (RR, 0.333; 95% CI, 0.087À1.272), arm II (RR, 0.5; 95% CI, 0.171À1.463), arm III (RR, 0.167; 95% CI, 0.024À1.145), and arm IV (RR, 0.667; 95% CI, 0.268À1.660). In intervention group, median HI significantly improved to 359 mmHg [interquartile range (IQR) 127À400, P = 0.009)] by outcome day, while the clinical status of intervention group also improved as compared to control group, with around 15 patients (37.5%) being discharged by 7th day with complete recovery. Additionally, resolution of chest X-rays and restoration of biomarkers to normal levels were also seen in intervention groups. No drug-related adverse events were reported during the study. Interpretation: Administration of C-IVIG in severe and critical COVID-19 patients was safe, increased the chance of survival and reduced the risk of disease progression. Funding: Higher Education Commission (HEC), Pakistan (Ref no. 20-RRG-134/RGM/R&D/HEC/2020).

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Section: Discussionmentioning

confidence: 99%

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial

Ali¹,

Uddin²,

Shalim³

et al. 2021

EClinicalMedicine

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show abstract

“…In recent issues, we have discussed the use of intravenous immunoglobulin and convalescent plasma. [ 3 4 ] The hypoinflammatory subphenotype manifests a disease similar to immunoparalysis in sepsis. In contrast, the hyperinflammatory subphenotype involves elevated levels of IL-6, IL-10, IL-8, and chemokines (e.g., C-X-C motif ligand [CXCL]-8, CXCL1, CXCL10, and C-C motif chemokine ligand-5).…”

mentioning

confidence: 99%

What's New in Critical Illness and Injury Science? Mortality effects of tocilizumab for patients admitted with COVID-19 pneumonia

Miller¹,

D'Silva²,

Gruber³

2021

International Journal of Critical Illness and Injury Science

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“…Consensus is lacking on how to characterize the severity and nature of the inflammatory response induced by SARS-CoV-2 infection; however, perturbations interleukin (IL)–1 β, IL-6, IL-10, tumor necrosis factor–α, and other cytokine and cellular mediators may play a significant role in pathophysiology, disease progression, and patient outcomes. [ 2 ]In recent issues, we have discussed the evidence of therapies such as intravenous immunoglobulin,[ 3 ]convalescent plasma,[ 4 ]and anti-IL 6[ 5 ]in the treatment of hospitalized and critically ill patients with COVID-19. This editorial will explore the effects of Janus Kinase inhibitors (JAKis) on mortality in patients hospitalized with COVID-19.…”

mentioning

confidence: 99%

What's new in critical illness and injury science? An evidence-based analysis of the impact of Janus Kinase inhibitors on 28-day mortality in patients admitted with COVID-19

Miller¹,

D'Silva²

2021

International Journal of Critical Illness and Injury Science

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What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness

Cited by 3 publications

References 18 publications

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial

What's New in Critical Illness and Injury Science? Mortality effects of tocilizumab for patients admitted with COVID-19 pneumonia

What's new in critical illness and injury science? An evidence-based analysis of the impact of Janus Kinase inhibitors on 28-day mortality in patients admitted with COVID-19

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