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.
Highlights
Towards the end of 2019, in the city of Wuhan, China, few cases of pneumonia were identified to be caused by a novel corona virus
The aim was to review the limited number of cases of severe critical COVID‐19 disease patients who were admitted in authors unit and treated with intravenous immunoglobulin (IVIg) along with institution’s standard of care (SOC) and to observe its effects on the clinical outcomes and inflammatory markers
All patients who presented to flu clinic with influenza like illness (ILI) at Fortis escorts Hospital, Jaipur, India, were tested for COVID-19 by real-time reverse transcription polymerase chain reaction from upper respiratory samples including both nasopharyngeal and oropharyngeal swabs and those with moderate, severe or critical respiratory illness were admitted to COVID-19 unit for further evaluation and management [13]
Summary
Towards the end of 2019, in the city of Wuhan, China, few cases of pneumonia were identified to be caused by a novel corona virus. The culprit virus was highly communicable, and it rapidly spread all over the world, resulting in a pandemic as declared by the World Health Organization on March 11th, 2020. In February 2020, the World Health Organization designated the disease as COVID-19, which stands for corona virus disease 2019. Since emergence of COVID-19 pandemic, not much specific and targeted pharmacological treatments are available yet. Besides Remdesivir, management of COVID-19 includes various pharmacologic interventions authorized under emergency use authorization (EUA) by FDA and includes anti SARS-COV2 antibody products (convalescent plasma, SARS-COV-2 specific immunoglobulin’s, sotrovimab, bamlanivimab plus Etesevemab or the casirivimab plus imdevimab combination), immunomodulation (corticosteroids, baricitinib+Remdesivir, interleukin (IL)-1 inhibitor Anakinra, Interferon beta), other immunotherapy’s (blocking antibodies to IL-6 receptor) and intravenous immunoglobulin have provided encouraging results [1].
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