Intravenous immunoglobulin therapy for COVID-19 in immunocompromised patients: A retrospective cohort study

• Published in: International journal of infectious diseases Vol. 144; p. 107046
• Main Authors: Gröning, Remigius, Walde, Jonatan, Ahlm, Clas, Forsell, Mattias N.E., Normark, Johan, Rasmuson, Johan
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.07.2024; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Neutralizing - blood; Antibodies, Neutralizing - immunology; Antibodies, Viral - blood; Antibodies, Viral - immunology; COVID-19; COVID-19 - immunology; COVID-19 - therapy; COVID-19 Drug Treatment; Female; Humans; Humoral immunity; Immunocompromised; Immunocompromised Host; Immunoglobulin G - blood; Immunoglobulins, Intravenous - administration & dosage; Immunoglobulins, Intravenous - therapeutic use; Intravenous immunoglobulin; Male; Middle Aged; Retrospective Studies; SARS-CoV-2; SARS-CoV-2 - immunology; Sweden; Treatment Outcome; Viral Load; Sweden; COVID-19; Intravenous immunoglobulin; SARS-CoV-2; Humoral immunity; Immunocompromised
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2024.107046

•Persistent COVID-19 in immunocompromised patients remains an unsolved problem.•Post-pandemic intravenous immunoglobulin (IVIG) holds SARS-CoV-2 neutralizing IgG.•We evaluated efficacy of IVIG in COVID-19 patients with failing humoral immunity.•Neutralizing antibodies in IVIG products were transferred to patients.•Infusion of IVIG was associated with clinical cure and viral clearance. To investigate the effectiveness of intravenous immunoglobulin (IVIG) as treatment for COVID-19 in immunocompromised patients. This retrospective study investigated outcomes for immunocompromised, vaccine non-responsive, patients that between September 2022 and April 2023 received IVIG as treatment for COVID-19 in the region of Västerbotten, Sweden. We analyzed clinical data, viral load, and anti-SARS-CoV-2 IgG binding and neutralization levels of patient serum samples and IVIG production batches. Primary and secondary outcomes were clinical cure and viral clearance, respectively. Sixteen patients were analyzed. After a median COVID-19 duration of 4 weeks, a median 60 g IVIG infusion increased SARS-CoV-2 binding and neutralizing antibody levels, with broad in vitro activity against tested variants. The treatment resulted in abrogation of viremia in all patients and general improvement in 15 survivors that all met the primary endpoint. Thirteen patients met the secondary endpoint at follow-up after a median of four months. Two subjects with persistent SARS-CoV-2 carriage relapsed but were successfully retreated with IVIG. Antibodies in IVIG efficiently neutralized several SARS-CoV-2 variants. Treatment with IVIG was associated with clinical cure and viral clearance in immunocompromised patients. Our data suggests that IVIG could be a novel treatment alternative for COVID-19 for this patient category.