High-Dose IVIG Can Improve Outcomes for Individuals with Severe COVID-19

High-dose intravenous immunoglobulin (IVIG) improves outcomes for individuals who have critical and severe COVID-19, according to the results of a study published in International Immunopharmacology.

The findings also showed that patient selection and timing are important factors when administering IVIG.

Various forms of immunomodulatory therapies have been evaluated to help manage dysregulated immune response from severe COVID-19 infections, including IVIG treatment. However, though some studies show the success of IVIG, others have failed to show any statistically significant benefits.

Investigators in the study aimed to evaluate whether using IVIG for individuals with critical and severe COVID-19 is beneficial.

In the study, 255 individuals received IVIG, along with standard treatment, while 280 received just the standard-of-care treatment. The 2 groups were matched with APACHE II score, COVID-19 severity, initial management, and oxygen requirement.

Investigators found that those in the IVIG group required invasive ventilation significantly less often than the standard-of-care group at 33.2% and 40.4%, respectively.

Additionally, in the IVIG Group, in-hospital mortality, length of stay (LOS) in the intensive care unit (ICU), and 28-day mortality were all significantly less.

Individuals who were treated with IVIG showed reduced in-hospital mortality of 10.2% and 28-day mortality of 8.9%.

Furthermore, the subgroup analysis showed that early administration, obesity, and older age, were all associated with better outcomes within the IVIG group.

Investigators included 535 individuals with critical and severe COVID-19, who were admitted to the ICU between May 2020 and December 2020.

The primary outcomes were considered the percentages of individuals requiring ventilation, while the secondary outcomes included LOS in the ICU, in-hospital modality, and 28-day mortality.

Additionally, the secondary outcomes included days to COVID-polymerase chain reaction negativity and days to discontinuation of supplemental oxygen, but there was no significant difference between the 2 groups.

All individuals in the IVIG group received a uniform high dose of IVIG with a median dose of IVIG of 35 g/day. Investigators said that a higher dose of IVIG could be the reason for improvement in mortality and oxygenation rates, especially since other studies have shown better results with higher doses.

Investigators used linear and logistic regression for adjusted and unadjusted analyses.

The logistic regression showed that earlier administration of IVIG resulted in improved outcomes, because of viremia that develops within the first week of infection, according to investigators.

Additionally, an individual’s primary immune response develops within the second week.

The findings showed that individuals who received IVIG within 7 days of hospital admission had better outcomes than those who received it later.

Investigators found that those who were aged 65 years or older had better outcomes. Additionally, those with a body mass index greater than 30 had better outcomes than individuals who were considered non-obese.

However, these outcomes could be because of a higher dose of IVIG dispensed to those who were obese, investigators said.

Investigators acknowledged that they were not able to compare the results with a placebo-control group, nor could they compare inflammatory markers or T cells before and after dispending IVIG, which could have provided more insight for the subgroup analysis.

Reference

Aggarwal R, Dewan A, Pandey A, Trehan N, Majid MA. Efficacy of high-dose intravenous immunoglobulin in severe and critical COVID-19: A retrospective cohort study. Int Immunopharmacol. 2022;106:108615. doi:10.1016/j.intimp.2022.108615