The effect of intravenous immunoglobulins on the outcomes of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Objectives

Severe-to-critical COVID-19 has been associated with exaggerated immune responses, and anti-inflammatory agents including corticosteroid and interleukin-6 antagonist have been repurposed as the treatment modality against severe SARS-CoV-2 infections. However, the clinical efficacy and safety of intravenous immunoglobulin (IVIG) in the treatment of patients with COVID-19 was controversial.

Methods

This meta-analysis of randomized controlled trials (RCTs) investigated the effectiveness of IVIG in patients with COVID-19. Electronic databases were searched for RCTs that compared the clinical efficacy of IVIG with standard of care or placebo in the hospitalized patients with COVID-19 were included.

Results

Six RCTs involving 472 patients were included. Patients who received IVIG had a similar mortality rate to the controls (25.3% vs 27.0%, odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.31). Compared with the control group, the study group demonstrated a similar incidence of receiving mechanical ventilation (OR, 0.70; 95% CI, 0.45–1.11), intensive care unit (ICU) admission (OR, 0.58; 95% CI, 0.22–1.53), length of hospital stay (mean difference [MD], −1.81 days; 95% CI, −8.42 to 4.81) and ICU stay (MD, −0.61 days; 95% CI, −2.80 to 1.58).  

Conclusions

The administration of IVIG in hospitalized patients with COVID-19 does not improve clinical outcomes.

KEYWORDS:

• COVID-19
• intravenous immunoglobulin
• IVIG
• mortality
• SARS-CoV-2

Article highlights

• Effective agents are urgently needed for severe COVID-19 patients to improve clinical outcome during this COVID-19 pandemic.

• Anti-inflammatory agents including corticosteroid and IL-6 antagonist have been purposed as the treatment modality against severe SARS-CoV-2 infections.

• Clinical efficacy and safety of intravenous immunoglobulin (IVIG) in the treatment of patients with COVID-19 was controversial.

• This meta-analysis demonstrated the administration of IVIG in hospitalized patients with COVID-19 does not improve clinical outcomes including mortality, need for mechanical ventilation or intensive care unit (ICU) admission, and length of hospital or ICU stay.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

C.-C. Lai and C.-Y. Chen contributed to the conception and design of the review article, C.-C. Lai and W.-C. Chen interpreting the relevant literature and statistical analysis, C.-C. Lai and Y.-F. Wei involved in writing the review article, all authors revised it for intellectual content, reviewed and agreed on all versions of the article before final submission.

Additional information

Funding

This paper was not funded.