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

25 Pages Posted: 26 Oct 2020

See all articles by Wei Cao

Wei Cao

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Xiaosheng Liu

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Ke Hong

Jinyintan Hospital - Center for Translational Medicine

Zhiyong Ma

Zhengzhou University - Henan Cancer Hospital

Yuelun Zhang

Chinese Academy of Medical Sciences - Medical Research Center

Ling Lin

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Yong Xiong

Wuhan University - Department of Infectious Disease

Zhengyin Liu

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Lianguo Ruan

Jin Yin-tan Hospital - Department of Infectious Disease

Taisheng Li

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

More...

Abstract

Background: The effective treatment of COVID-19 remains unclear. We reported successful use of high-dose intravenous immunoglobulin (IVIg) in cases of severe COVID-19, but evidence for such treatment 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 propensity score-matched (PSM) and inverse probability of treatment weighting (IPTW) analysis.

Results: Overall, 26 patients who received high-dose IVIg with standard therapy and 79 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 0.28 (95%CI 0.06-1.10, p=0.061) in propensity score-matched (PSM) analysis, and 0.24 (95%CI 0.06-0.99, p<0.001) in inverse probability of treatment weighting (IPTW) adjustment. 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.

Funding Statement: None.

Declaration of Interests: All authors declared no competing financial interests.

Ethics Approval Statement: The study protocol was approved by the institutional ethics board of Peking Union Medical College Hospital (PUMCH, No. ZS-2299, Feb 6, 2020), and all participants provided written consent for participating this study.

Keywords: COVID-19, high-dose intravenous immunoglobulin, immunomodulation, 28-day mortality, inflammatory markers

Suggested Citation

Cao, Wei and Liu, Xiaosheng and Hong, Ke and Ma, Zhiyong and Zhang, Yuelun and Lin, Ling and Xiong, Yong and Liu, Zhengyin and Ruan, Lianguo and Li, Taisheng, High-Dose Intravenous Immunoglobulin in Severe Coronavirus Disease 2019: A Multicenter Retrospective Study in China. Available at SSRN: https://ssrn.com/abstract=3696870 or http://dx.doi.org/10.2139/ssrn.3696870

Wei Cao

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Beijing, 100730
China

Xiaosheng Liu

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases ( email )

Beijing, 100730
China

Ke Hong

Jinyintan Hospital - Center for Translational Medicine

Zhiyong Ma

Zhengzhou University - Henan Cancer Hospital

Zhengzhou
China

Yuelun Zhang

Chinese Academy of Medical Sciences - Medical Research Center

1 Shuaifuyuan
Beijing, 100730
China

Ling Lin

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Beijing, 100730
China

Yong Xiong

Wuhan University - Department of Infectious Disease ( email )

China

Zhengyin Liu

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Beijing, 100730
China

Lianguo Ruan

Jin Yin-tan Hospital - Department of Infectious Disease ( email )

Wuhan
China

Taisheng Li (Contact Author)

Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC) - Department of Infectious Diseases

Beijing, 100730
China

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