When intravenous immunoglobulin (IVIG) is administered to hypoxic non-ventilated coronavirus disease 2019 (COVID-19) patients with an A-a gradient of more than 200 mg Hg, IVIG significantly decreases the rates of progression to mechanical ventilation, ICU length of stay, and total hospital length of stay, according to data presented at the American Society of Hematology Annual Meeting and Exposition on December 6, 2020.

The majority of COVID-19 morbidity and mortality occurs in patients who progress to mechanical ventilation. Therefore, therapeutic interventions targeting the mitigation of this complication would markedly improve outcomes and reduce health care utilization, according to the study authors.

Patients with COVID-19 from 2 hospitals in San Diego, California were randomized at a 1:1 ratio to receive standard of care (SOC) plus IVIG at 0.5 g/kg/day over 3 days with solumedrol (40 mg) 30 minutes before infusion (IVIG group) versus SOC alone. The primary endpoint was receipt of mechanical ventilation or death before receiving ventilation, and patients were followed until discharge to home or up to 30 days from time of enrollment.

Further, 16 patients received IVIG plus SOC and 17 SOC alone, with a median age of 54 years for SOC and 57 years of age for IVIG. Median time from hospital admission to study enrollment was 1 day for SOC and 2 days for IVIG. APACHE 2 scores and Charlson comorbidity indices were similar for IVIG and SOC, respectively.

Seven SOC patients achieved the composite endpoint versus 2 IVIG patients. Among the subgroup with an estimated A-a gradient of more than 200 mm Hg at time of enrollment, the IVIG group showed a lower rate of progression to the composite endpoint, shorter median hospital length, and shorter median intensive care unit stay.

Sakoulas G, Geriak M, Kullar R, et al. Use of Intravenous Immunoglobulin Therapy Reduces Progression to Mechanical Ventilation in COVID‑19 Patients with Moderate to Severe Hypoxia. Poster presented at ASH Annual Meeting and Exposition. December 6, 2020. https://ash.confex.com/ash/2020/webprogram/Paper141003.html.