Background The effective treatment of coronavirus disease 2019 (COVID-19) remains unclear. We reported successful use of high-dose intravenous immunoglobulin (IVIg) in cases of severe COVID-19, but evidence from larger case series is still lacking. Methods A multi-center retrospective study was conducted to evaluate the effectiveness of IVIg administered within two weeks of disease onset at a total dose of 2 g/kg body weight, in addition to standard care. The primary endpoint was 28-day mortality. Efficacy of high-dose IVIg was assessed by using the Cox proportional hazards regression model and the Kaplan-Meier curve adjusted by inverse probability of treatment weighting (IPTW) analysis, and IPTW after multiple imputation (MI) analysis. Results Overall, 26 patients who received high-dose IVIg with standard therapy and 89 patients who received standard therapy only were enrolled in this study. The IVIg group was associated with a lower 28-day mortality rate and less time to normalization of inflammatory markers including IL-6, IL-10, and ferritin compared with the control. The adjusted HR of 28-day mortality in high-dose IVIg group was 0.24 (95% CI 0.06–0.99, p<0.001) in IPTW model, and 0.27 (95% CI 0.10–0.57, p=0.031) in IPTW-MI model. In subgroup analysis, patients with no comorbidities or treated in the first week of disease were associated with more benefit from high-dose IVIg. Conclusions High-dose IVIg administered in severe COVID-19 patients within 14 days of onset was linked to reduced 28-day mortality, more prominent with those having no comorbidities or treated at earlier stage.
【저자키워드】 COVID-19, high-dose intravenous immunoglobulin, immunomodulation, 28-day mortality, inflammatory markers, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, Intravenous immunoglobulin, severe COVID-19, IL-6, body weight, Comorbidities, 28-day mortality, inflammatory markers, Comorbidity, ferritin, IVIG, Probability, Retrospective study, Immunoglobulin, Regression model, Patient, Effectiveness, Inflammatory marker, mortality rate, IL-10, disease, Evidence, primary endpoint, Analysis, dose, Standard therapy, disease onset, High-dose, multiple imputation, 95% CI, standard care, severe COVID-19 patients, Cox proportional hazards regression model, high-dose IVIg, Kaplan-Meier curve, normalization, subgroup analysis, Administered, Weighting, effective, benefit, Result, enrolled, evaluate, reported, addition, conducted, reduced, case sery, treated, adjusted, less, Cox proportional hazard, severe COVID-19 patient, 【제목키워드】 China,