Intravenous Immunoglobulin Therapy

Last review completed on
June 7th, 2020

Intravenous immunoglobulin (IVIG) therapy can suppress a wide variety of autoimmune and chronic inflammatory diseases.

Recommendation

There is not enough evidence to recommend use of this medication for the treatment of COVID-19.

Level of Evidence
= Supporting use article = Neutral Article  = Contradicting use article

Step 1 - In vitro SARS CoV-1/2 and MERS-CoV Step 2 - In vivo MERS-CoV Step 3 - In vivo SARS CoV-2
Supportive Use articleSupportive Use article

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Peer reviewed articles

 Observational SARS CoV-2

  1. Cao W, Liu X, Bai T, et al. High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019. Open Forum Infect Dis. 2020;7(3):ofaa102. Published 2020 Mar 21. doi:10.1093/ofid/ofaa102
    1. Case series of 3 patients with COVID-19 in China
    2. High dose IVIg (25 g/d or 0.3–0.5 g/kg/d) for 5 days
    3. Patient 1: started IVIG on hospital day (HD) 7, illness day (ID) 10
    4. Patient 2: started IVIG on HD 2 (ID 12), also received lopinavir/ritonavir for 14 days
    5. Patient 3: started IVIG on HD 6 (ID 11), also received methylprednisolone for 3 days 2.
  2. Xie Y, Cao S, Dong H, et al. Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID-19 [published online ahead of print, 2020 Apr 10]. J Infect. 2020;S0163-4453(20)30172-9. doi:10.1016/j.jinf.2020.03.044
    1. Retrospective cohort study of 58 severe or critically ill COVID-19 patients in the Wuhan Third Hospital
    2. Patients received:
      1. Abidor
      2. Moxifloxacin
      3. IVIg (20 g/d)
      4. LMWH for anticoagulation (depending on patient’s condition)
      5. Thymosin, if lymphocytes < 0.5 x 109/L 5 days after IVIg
      6. Glucocorticoids (1-2 mg/kg) [specific drug not mentioned], for 5-7 days if critically ill
    3. Administration of IVIg within 48 hours of admission was associated with a decrease in 28 day mortality (23.3% vs 57.1%, p = 0.009), hospital LOS (11.50 ± 1.030 vs 16.96 ± 1.620 days, p = 0.0055), ICU LOS (9.533 ± 1.089 vs 13.50 ± 1.632 days, p = 0.0453), and proportion of patients requiring mechanical ventilation (6.67% vs 32.14%, p = 0.016) when compared to those who received IVIg 48 hours or greater after admission

Clinical Trials

There is a clinical trial studying IVIg therapeutic agent:

Blood-Derived Products