Intravenous Immunoglobulin Therapy in COVID-19 Disease

Authors : Elif ŞEKER, Öner ÖZDEMİR, Ayşegül PALA

Pages : 470-472

Doi:10.31832/smj.799820

View : 26 | Download : 10

Publication Date : 2021-06-29

Article Type : Other Papers

Abstract :High dose IVIG has been an appropriate immunomodulatory treatment option for prophylaxis of severe infections in autoimmune and inflammatory diseases [1]. It is suggested that the plasma levels of pro-inflammatory cytokines are higher in COVID-19 patients with severe clinical course and there is a cytokine storm related to the severity of the disease. Therefore, IVIG is presented as a treatment option in severe COVID-19 patients [2]. Mechanisms suggesting the benefit of IVIG in SARS-CoV2 therapy can be counted as; neutralizing antibodies binding to the ACE2 receptor to prevent viral entry into the cell, blocking receptors associated with the target cell and preventing pathogens from damaging the cell [3,4]. In addition, IVIG has IgG dimers that inhibit FcR activation on natural immune effector cells. This prevents antibody-dependent enhancement insert ignore into journalissuearticles values(ADE);, a paradoxical condition that allows the pathogen to enter the cell [5,6]. It has also been observed to improve coagulation abnormalities in septic patients that deteriorate due to inflammatory events in the pathogenesis of COVID-19 [7]. In previous studies of SARS and MERS, the benefit of IVIG treatment has been demonstrated [8]. Wang et al. reported that 40 patients with SARS were given IVIG, 22 of whom had severe cytopenia, and a significant improvement in leukocyte and platelet counts was noted after IVIG [9]. In a case series reported by Cao et al., IVIG was given 0.3-0.5 g per kg weight per day for five days to 3 patients with severe COVID-19 pneumonia diagnosed by CT scan. It was reported that patients showed a rapid recovery 2 days after IVIG treatment and their CT scan findings were improved. In addition, no side effects were reported in any of the 3 patients [10]. Lanza et al. reported an increased need for oxygen in 42-year-old woman diagnosed with COVID-19 on the 6th day and bilateral infiltration and consolidation worsened in the CT findings, and the radiological findings and blood values were rapidly improved after 4 days of high-dose IVIG treatment [3]. IVIG can interrupt the storm of inflammatory factors at an early stage, enhance immune function. Ling and colleagues recommended early initiation of IVIG treatment for severe and critical type COVID-19 patients [11]. In summary, early use of IVIG therapy in selected cases for COVID-19 pneumonia has been reported to shorten hospital stay, reduce the need for mechanical ventilation, and benefit patients` early recovery. More controlled studies are needed to demonstrate therapeutic benefits of this IVIG therapy.
Keywords : covid 19, ivig, therapy