Use of Intravenous Immunoglobulin in the Treatment of Severe COVID-19 Disease – A Case Series

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  •   Arun Agarwal

  •   Rekha Jakhar

  •   Ambika Sharma

  •   Aakanksha Agarwal

Abstract


Objective: To study and document the outcomes of adjuvant use of high dose intravenous immunoglobulin (IVIg) therapy in patients with severe or critical corona virus disease 2019 (COVID-19). We report in a case series of five patients who were admitted with severe and critical COVID-19 disease and were treated with adjuvant IVIG along-with the institute's standard of care (SOC) treatment.




Methods: It is a retrospective observational study. We retrospectively collected data on all patients with COVID-19 disease who were hospitalized in author’s unit. The severe and critical disease patients who received IVIg were shortlisted and are discussed.




Results: Data from 101 patients were analyzed. Of them 5 patients were treated with IVIG along with institution’s SOC. 4 patients were male and 1 was female. Except one patient (P2) all were above 60 years of age and all had one or more co morbidities with Diabetes mellitus (DM) and Hypertension (HT) present all of them. 3 patients had past history of pulmonary tuberculosis (P1, P4 and P5). P2 had chronic kidney disease (CKD) and P4 had coronary artery disease (CAD) with cardiac resynchronization therapy (CRT) device in situ. Median length of stay was 13 days and 4 of them were discharged.




Conclusions: This small case series demonstrates that administration of IVIg in patients with severe COVID-19 disease, who did not respond to usual standard of care treatment, could improve clinical outcome and reduce mortality rate. It should be especially considered in cases with severe critical COVID-19 disease along with evidence of hyper inflammation /cytokine storm. Clinical efficacy is possibly driven by its anti-cytokine effects, reduction of inflammation by inhibition of complement activation, and down-regulation of B and T cells’ functions. Among the various inflammatory markers IVIg reduced CRP and D Dimer levels. It did not show relevant effect on other inflammation markers. However, multicenter studies with large sample size are needed to substantiate these observations.



Keywords: COVID-19, cytokine storm, immunotherapy, IVIg, SARS-CoV-2

References

R. Bonam, S. V. Kaveri, A. Sakuntabhai, L. Gilardin and J. Bayry, “Adjunct immunotherapies for the management of severely ill COVID-19 Patients,” Cell Reports Medicine 1(2): 100016, 2020.

C. Galeotti, S. V. Kaveri and Bayry, J, “Intravenous immunoglobulin immunotherapy for coronavirus disease-19 (COVID-19),” Clinical & Translational Immunology 9(10): e1198, 2020.

J. B. Moore and C. H. June, “Cytokine release syndrome in severe COVID-19,” Science 368(6490):473–474.

N. Mohtadi, A. Ghaysouro, S. Shirazi, A. Sara, E. Shafiee, E. Bastani, T. Kokhazadeh and H. Tavan, “Recovery of severely ill COVID-19 patients by intravenous immunoglobulin (IVIG) treatment: A case series,” Virology 548:1-5, 2020.

H. Shi, C. Zhou, P. He, S. Huang, Y. Duan, X. Wang and Y. Zha, “Successful treatment with plasma exchange followed by intravenous immunoglobulin in a critically ill patient with COVID-19,” International Journal of Antimicrobial Agents 105974, 2020.

W. Cao, X. Liu, T. Bai, H. Fan, K. Hong, H. Song and T. Lie, “High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients with Coronavirus Disease 2019,” Open Forum Infectious Diseases 7(3), 2020.

M. Lanza, G. E. Polistina, P. Imitazione, A. Annunziata, V. Di Spirito, C. Novella and G. Fiorentino, “Successful intravenous immunoglobulin treatment in severe COVID-19 pneumonia,” IDCases e00794 - e00794, 2020.

K. Chiotos, H. Bassiri, E. M. Behrens, A. M. Blatz, J. Chang, C. Diorio and A. R. O. John, “Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series,” Journal of Pediatric Infectious Disease Society 9(3): 393-398, 2020.

Z. Shao, Y. Feng, L. Zhong, Q. Xie, M. Lei, Z. Liu, C. Wang, J. Ji, L. Huiheng, Z. Gu, Z. Hu, L. Su, M. Wu and Z. Liu, “Clinical efficacy of intravenous immunoglobulin therapy in critical patients with COVID-19: A multicenter retrospective cohort study,” medRxiv [Online] 2020.

Y. Xie, S. Cao, H. Dong, Q. Li, E. Chen, W. Zhang and R. Wang, “Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID-19,” Journal of Infection 81(2): 318-356, 2020.

Z. G. Zhou, S. M. Xie, J. Zhang, F. Zheng, J. H. Liu, C. L. Cai and L. Zhang, “Short-Term Moderate-Dose Corticosteroid Plus Immunoglobulin Effectively Reverses COVID-19 Patients Who Have Failed Low-Dose Therapy,” Preprints, 2020.

FDA News Release: Coronavirus (COVID-19) Update: FDA Coordinates National Effort to Develop Blood-Related Therapies for COVID-19. April 3, 2020. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-coordinates-national-effort-develop-blood-related-therapies-covid-19.

R. T. Gandhi, J. B. Lynch and C. del Rio, “Mild or Moderate Covid-19”, New England Journal of Medicine 383:1757-66, 2020.

A. Agarwal, A. Sharma, R. Jakhar and M. Agarwal, “Severe Acute Acrocyanosis and Digital gangrene as a sign of Catastrophic COVID19 infection”, Journal of Clinical and Diagnostic Research 15(4): OD12-OD15, 2021.

M. Prokop, W. van Everdingen, T. van Rees Vellinga, H. Quarles van Ufford, L. Stöger, L. Beenen, B and COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society, “CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation,” Radiology 296(2): E97-E104, 2020.

Z. Shao, Y. Feng, L. Zhong, Q. Xie, M. Lei, Z. Liu and Z. Liu, “Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID-19: a multicenter retrospective cohort study”, Clinical and Translational Immunology 9(10): e1192, 2021.

G. Sakoulas, M. Geriak, R. Kullar, K. L. Greenwood, M. K. Habib, A. Vyas and F. Haddad, “Intravenous immunoglobulin (IVIG) significantly reduces respiratory morbidity in COVID‐19 pneumonia: a prospective randomized trial”, medRxiv, [Online] 2020.

M. Zantah, E. D. Castillo, A. J. Gangemi, M. Patel, J. Chowdhury, S. Verga and R. Carricchio, “Anakinra and intravenous IgG versus tocilizumab in the treatment of COVID‐19 pneumonia”, medRxiv [Online], 2020.

W. J. Wiersinga, A. Rhodes, A. C. Cheng, S. J. Peacock and H. C. Prescott, “Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review,” JAMA 324(8): 782-793, 2020.

M. H. Cheng, S. Zhang, R. A. Porritt, M. Noval Rivas, L. Paschold, E. Willscher and I. Bahar, “Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients with hyperinflammation,” Proceedings of the National Academy of Sciences of the United States of America 117(41): 25254-25262, 2020.

J. M. Díez, C. Romero and R. Gajardo, “Currently available intravenous immunoglobulin contains antibodies reacting against severe acute respiratory syndrome coronavirus 2 antigens,” Immunotherapy 12(8): 571-576, 2020.

M. Buszko, J. H. Park, D. Verthelyi, R. Sen, H. A. Young and A. S. Rosenberg, “The dynamic changes in cytokine responses in COVID-19: a snapshot of the current state of knowledge”, National Immunology 21(10):1146-1151, 2020.

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How to Cite
Agarwal, A., Jakhar, R., Sharma, A. ., & Agarwal, A. . (2021). Use of Intravenous Immunoglobulin in the Treatment of Severe COVID-19 Disease – A Case Series. European Journal of Medical and Health Sciences, 3(5), 38–44. https://doi.org/10.24018/ejmed.2021.3.5.1061