High-Dose Intravenous Immunoglobulin in Severe Coronavirus Disease 2019: A Multicenter Retrospective Study in China

• Published in: Frontiers in immunology Vol. 12; p. 627844
• Main Authors: Cao, Wei, Liu, Xiaosheng, Hong, Ke, Ma, Zhiyong, Zhang, Yuelun, Lin, Ling, Han, Yang, Xiong, Yong, Liu, Zhengyin, Ruan, Lianguo, Li, Taisheng
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 19.02.2021
• Subjects: 28-day mortality; Adult; Aged; China - epidemiology; COVID-19; COVID-19 - blood; COVID-19 - drug therapy; COVID-19 - mortality; Disease-Free Survival; Female; Ferritins - blood; high-dose intravenous immunoglobulin; Humans; Immunoglobulins, Intravenous - administration & dosage; Immunology; immunomodulation; inflammatory markers; Interleukin-10 - blood; Interleukin-6 - blood; Male; Middle Aged; Retrospective Studies; SARS-CoV-2 - metabolism; Survival Rate; China; COVID-19; 28-day mortality; immunomodulation; inflammatory markers; high-dose intravenous immunoglobulin
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2021.627844

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. 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. 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. 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.