Current best evidence for clinical care (more info)
BACKGROUND: Currently, there is no specific drug for the treatment of coronavirus disease 2019 (COVID-19). Therapeutic benefits of intravenous immunoglobulin (IVIG) have been demonstrated in wide range of diseases. The present study is conducted to evaluate the safety and efficacy of IVIG in the treatment of COVID-19 patients with moderate pneumonia.
METHODS: An open-label, multicenter, comparative, randomized study was conducted on COVID-19 patients with moderate pneumonia. One hundred eligible patients were randomized in 1:1 ratio either to receive IVIG + standard of care (SOC) or SOC.
RESULTS: Duration of hospital stay was significantly shorter in the IVIG group compared with that of SOC alone (7.7 vs 17.5 days). Duration for normalization of body temperature, oxygen saturation, and mechanical ventilation were significantly shorter in IVIG compared with SOC. Percentages of patients on mechanical ventilation in 2 groups were not significantly different (24% vs 38%). Median time to reverse-transcription polymerase chain reaction negativity was significantly shorter with IVIG than SOC (7 vs 18 days). There were only mild to moderate adverse events in both groups except for 1 patient (2%), who died in SOC.
CONCLUSIONS: Intravenous immunoglobulin was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19.
| Discipline / Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Respirology/Pulmonology | |
| Intensivist/Critical Care | |
| Infectious Disease | |
This study suggests that IVIG has beneficial effect in patients with moderately severe COVID-19 pneumonia. There are some issues with the methodology: The primary endpoint was days from treatment initiation to discharge, but it is not clear when exactly patients initiated IVIG, and if the patients from the two groups were recruited to the study at a similar stage of disease. Another significant problem is that Standard of Care did not include corticosteroids, remdesivir or tocilizumab, which are used in many settings as SOC.
The study results appear too good. However, the sample size is very small and the patients were from the moderate category. More studies need to be conducted soon.
On the face of it, this is an exciting result. It's open label and there is no placebo. The numbers were smallish, but there was a clear benefit. There was only 1 death (in SOC group) so probably fairly mild pneumonia. The standard care group had such lengthy admissions as it would appear the pneumonia wasn't that severe.