High-Dose IVIG Reduces Mortality Risk in Hospitalized Patients with Severe COVID-19: Systematic Review and Meta-Analysis

A systematic search of leading databases and registries by Chinese collaborators identified a total of 17 clinical trials and observational studies, including 1,925 intravenous immune globulin (IVIG)-treated and 2,786 control patients, that compared the efficacy of IVIG to routine care for hospitalized COVID-19 patients.

Administration of IVIG was not associated with a significant reduction in all-cause mortality across all COVID-19 patients receiving any dosage of IVIG (relative risk [RR], 0.89; 95% confidence interval [CI], 0.63 to 1.26; P – 0.53). There were similarly no significant differences compared to standard care with respect to length of hospital stay (mean difference, 0.29 days; 95% CI, -3.40 to 6.44 days; P = 0.88), need for mechanical ventilation (RR, 0.93; 95% CI, 0.73 to 1.19; P = 0.31) or incidence of adverse events (RR, 1.15; 95% CI, 0.99 to 1.33; P = 0.06).

However, a subgroup analysis focusing on the mortality-related impact of variable IVIG daily dosage and disease severity found significantly reduced overall mortality in the patient subgroup with severe COVID-19 that received high-dose IVIG (RR, 0.33; 95% CI, 0.13 to 0.86; P = 0.02; very low certainty). High-dose IVIG therapy was defined as 0.3 to 0.5 grams per kilogram of body weight per day for five days.

“High-dose IVIG might reduce mortality in patients with severe COVID-19,” the authors concluded. “However, [due to the] combination of low quality of certainty due to the limited number of studies and the high risk [of] methodological heterogeneity, the results should be interpreted with great caution, and more research is needed to understand its specific effects.”