高剂量的静脉免疫球蛋白可提高重症新冠肺炎疗效

Introduction: High-dose intravenous immune globulin (IVIG) has better efficacy in treating severe novel coronavirus pneumonia (COVID-19).

Research results released by International Immunopharmacology show that high-dose intravenous immune globulin (IVIG) has better efficacy in treating severe COVID-19.

The results also indicate that patient selection and timing are important factors to consider when administering intravenous immune globulin (IVIG) injections.

Various immunomodulatory therapies have been previously evaluated to address the immune dysregulation response to severe COVID-19 infection, including intravenous immune globulin (IVIG) therapy. However, while some studies have demonstrated the effectiveness of this approach, others have not shown any statistically significant benefit.

Researchers in this trial aimed to evaluate whether intravenous immune globulin (IVIG) would be beneficial in patients with severe cases of novel coronavirus pneumonia (COVID-19).

Patients were divided into 2 groups based on APACHE II score, COVID-19 severity, initial management, and oxygen requirement. 255 people received intravenous immune globulin (IVIG) plus standard care, and the other 280 received standard care alone.

The study found that the proportion of patients requiring invasive ventilation in the IVIG group was significantly lower than that in the standard care group, 33.2% and 40.4% respectively.

In addition, in-hospital mortality, intensive care unit (ICU) length of stay (LOS), and 28-day mortality were significantly lower in the IVIG group.

Patients in the IVIG group had a 10.2% reduction in in-hospital mortality and an 8.9% reduction in 28-day mortality.

In addition, subgroup analysis showed that patients who took the drug early, were obese, and were older showed better efficacy.

The trial included a total of 535 patients with severe novel coronavirus pneumonia (COVID-19) who were admitted to the ICU between May and December 2020.

The primary endpoint of the trial is the proportion of patients requiring a ventilator, and secondary endpoints include ICU length of stay, in-hospital mortality, and 28-day mortality.

In addition, secondary endpoints included the number of COVID-PCR negative days and the number of days without oxygen supplementation, but these two indicators did not differ significantly between the two groups.

All patients in the IVIG group received high-dose intravenous immune globulin (IVIG), with a median dose of 35 g/day. The researchers said that higher doses of intravenous immune globulin (IVIG) may be responsible for the improvement in mortality and oxygenation rates, and other studies have shown that higher doses of intravenous immune globulin (IVIG) are more effective.

The researchers used linear and logistic regression to conduct parameter-adjusted and unparameter-adjusted analyses.

Logistic regression analysis showed that viremia usually occurs within the first week after infection, so giving intravenous immune globulin (IVIG) as early as possible may lead to better efficacy.

Furthermore, the patient's main immune response appeared within the second week.

Patients who received intravenous immune globulin (IVIG) within 7 days of admission showed better outcomes than those who received IVIG later.

Patients aged 65 or older had better outcomes. Patients with a body mass index greater than 30 have better outcomes than non-obese patients.

However, the researchers said the difference due to body mass index may be because obese patients were given higher doses of intravenous immune globulin (IVIG).

Researchers on the trial acknowledge that they are currently unable to compare results to a placebo control group or to compare changes in inflammatory markers or T cells before and after intravenous immune globulin (IVIG) injections, although this would have provided more information for subgroup analyses.

References:

https://www.pharmacytimes.com/view/high-dose-ivig-can-improve-outcomes-for-individuals-with-severe-covid-19