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High-Dose Intravenous Immunoglobulin in Severe Coronavirus Disease 2019: A Multicenter Retrospective Study in China
Wei Cao1, Xiaosheng Liu1,2,3, Ke Hong4
1Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Insights
High-dose intravenous immunoglobulin (IVIg) treatment for severe COVID-19 patients reduced 28-day mortality. Early treatment and no comorbidities were associated with greater benefits from IVIg therapy.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- The optimal treatment for coronavirus disease 2019 (COVID-19) remains an area of active investigation.
- Previous reports suggested potential benefits of high-dose intravenous immunoglobulin (IVIg) in severe COVID-19 cases.
- Larger case series are needed to confirm the efficacy of IVIg for COVID-19.
Purpose of the Study:
- To evaluate the effectiveness of high-dose IVIg as an adjunct therapy in severe COVID-19 patients.
- To assess the impact of IVIg on 28-day mortality and inflammatory markers.
Main Methods:
- A multi-center retrospective study involving 26 patients receiving high-dose IVIg (2 g/kg) plus standard care and 89 patients receiving standard care alone.
- The primary endpoint was 28-day mortality.
- Statistical analysis included Cox proportional hazards regression and Kaplan-Meier curves, adjusted using inverse probability of treatment weighting (IPTW) and multiple imputation (MI).
Main Results:
- The high-dose IVIg group demonstrated a significantly lower 28-day mortality rate compared to the control group (adjusted HR 0.24-0.27).
- IVIg administration led to a faster normalization of inflammatory markers, including IL-6, IL-10, and ferritin.
- Subgroup analysis indicated greater benefits in patients without comorbidities and those treated within the first week of disease onset.
Conclusions:
- High-dose IVIg administered within 14 days of onset is associated with reduced 28-day mortality in severe COVID-19 patients.
- The therapeutic effect of IVIg appears more pronounced in patients with no comorbidities and those receiving treatment earlier in the disease course.
Background:
The effective treatment of coronavirus disease 2019 (COVID-19) remains unclear. We reported successful use of high-dose intravenous immunoglobulin (IVIg) in cases of severe COVID-19, but evidence from larger case series is still lacking.
Methods:
A multi-center retrospective study was conducted to evaluate the effectiveness of IVIg administered within two weeks of disease onset at a total dose of 2 g/kg body weight, in addition to standard care. The primary endpoint was 28-day mortality. Efficacy of high-dose IVIg was assessed by using the Cox proportional hazards regression model and the Kaplan-Meier curve adjusted by inverse probability of treatment weighting (IPTW) analysis, and IPTW after multiple imputation (MI) analysis.
Results:
Overall, 26 patients who received high-dose IVIg with standard therapy and 89 patients who received standard therapy only were enrolled in this study. The IVIg group was associated with a lower 28-day mortality rate and less time to normalization of inflammatory markers including IL-6, IL-10, and ferritin compared with the control. The adjusted HR of 28-day mortality in high-dose IVIg group was 0.24 (95% CI 0.06-0.99, p<0.001) in IPTW model, and 0.27 (95% CI 0.10-0.57, p=0.031) in IPTW-MI model. In subgroup analysis, patients with no comorbidities or treated in the first week of disease were associated with more benefit from high-dose IVIg.
Conclusions:
High-dose IVIg administered in severe COVID-19 patients within 14 days of onset was linked to reduced 28-day mortality, more prominent with those having no comorbidities or treated at earlier stage.
