When IVIG was administered within 48 hours of hospital admission, hospital and ICU length of stay were dramatically shortened.
In patients who are immunocompromised with viral respiratory infections, intravenous immunoglobulin (IVIG) was associated with shorter hospital and intensive care unit (ICU) length of stay (LOS), particularly when administered within 48 hours of admission, according to a double-center, retrospective analysis published in Annals of Allergy, Asthma & Immunology.1
IVIG could decrease length of stay for respiratory infections. © Pairat | stock.adobe.com
Viral respiratory tract infections (VRTI) can be severe in patients who are immunocompromised, with those having hematologic malignancies being especially vulnerable to severe VRTIs. Currently, no known effective therapeutics exist for patients hospitalized with a VRTI.1
The role of IVIG in these patients has been reported in only a handful of uncontrolled, small cohorts and in case reports. However, IVIG has been reported to reduce the risk of infections in multiple other scenarios. For example, IVIG was found to reduce the risk of severe infection in those with multiple myeloma undergoing bispecific antibody treatment.2
Additionally, IVIG was observed to be effective in achieving viral clearance in patients with COVID-19, and effectively neutralize multiple variants of SARS-CoV-2. Importantly, in immunocompromised patients, IVIG was linked with clinical cure from COVID-19.3
Given the success of IVIG in preventing infections in these occurrences and others, such as in those with hypogammaglobulinemia and following bone marrow transplants, the investigators sought to assess the outcomes and economic impact of IVIG treatment in patients who are immunocompromised and hospitalized with VRTI.1
Primary outcomes of the study were overall hospital LOS and ICU LOS. The LOS was defined as the number of days from the date of admission to the date of discharge, and excluded patients who passed away during their hospital stay. Some secondary clinical outcomes included hospital readmission, death during hospitalization, and serious IVIG side effects.1
There were 270 patients included in the cohort, of which 97 (35.6%) received IVIG and 173 (64.4%) did not. Mean LOS was observed to be 9.6 days. Three percent of the patients died during hospitalization and 26.7% died before the follow-up point, while 30 (11.1%) patients were admitted to the ICU. In a positive result, no serious side effects were seen in any patient who received IVIG.1
Through adjusted analyses, the investigators determined that receiving IVIG was significantly associated with a shorter ICU LOS, with 0.5 fewer days spent in the ICU (β = -0.534, P = .012), and a longer overall hospital LOS (β = 0.887, P < .01). There were no associations found between IVIG and readmission to the hospital in the adjusted analysis, and the investigators had insufficient evidence to associate IVIG with death during hospitalization.1
1. In immunocompromised patients with respiratory infections, IVIG decreased hospital and intensive care unit length of stay.
2. The effect was most pronounced within 48 hours of being admitted to the hospital.
3. There were no significant safety concerns associated with IVIG administration.
Next, the investigators narrowed their analysis to receiving IVIG in the first 48 hours of hospital admission. They found that IVIG in the first 48 hours was associated with a shorter ICU LOS (β = -0.297, P = 0.479), in addition to a significant association with a shorter overall hospital LOS (β = -0.274, P < .001).1
According to the investigators, this study is among the first and largest to evaluate the effect that IVIG has in the acute setting in immunocompromised patients hospitalized with VRTIs. The propensity of IVIG to be more effective in reducing LOS when administered within 48 hours was notable and corroborates with other investigations when immunomodulators were administered in the early stages of infection.1
It is important to note that this study took place before the onset of the COVID-19 pandemic and evaluated patients with respiratory viruses other than SARS-CoV-2. This realization makes the trial analyzing IVIG’s effect on COVID-19 a good source of comparison for the results, as each trial evaluated immunocompromised patients with a viral respiratory infection.1,3
Multiple strengths of the study were documented, including the confirmation of a VRTI in all patients through a viral PCR, as well as chest imaging. The investigators were also able to find significant associations between IVIG administration and hospitalized patients in various patient subpopulations.1
“Our data provides evidence to justify future prospective clinical studies to further evaluate in a randomized fashion the efficacy and safety of IVIG in hospitalized immunocompromised patients with VRTIs,” the study authors concluded.1
