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

Frontiers in Immunology

Lianguo Ruan²  Ke Hong²  Yang Han³  Ling Lin³  Wei Cao³  Zhengyin Liu³  Yong Xiong⁴  Zhiyong Ma⁴  Yuelun Zhang⁵  Xiaosheng Liu⁶  Taisheng Li⁶ 

[1] Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, China;Department of Infectious Diseases, Jin Yin-tan Hospital, Wuhan, China;Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China;Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China;Medial Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China;Tsinghua-Peking Center for Life Sciences, Beijing, China;

关键词: COVID-19;    high-dose intravenous immunoglobulin;    immunomodulation;    28-day mortality;    inflammatory markers;   

DOI  :  10.3389/fimmu.2021.627844

来源: DOAJ

【 摘 要 】

BackgroundThe 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.MethodsA 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.ResultsOverall, 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.ConclusionsHigh-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.

【 授权许可】

Unknown