Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit

Abstract

Background: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). Methods: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). Results: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). Conclusion: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

A fatal toxic shock-like syndrome post COVID-19 infection in a child

“…Other biologic immunomodulators may be considered in severe cases with no response to anakinra. Infliximab and tocilizumab, used in other hyper-inflammatory syndromes as biologic immunomodulators have been tried to modulate the dysregulated hyper-inflammation apparent in MIS-C with promised result in adults [ 20 , 21 ]. However, there is limited evidence to suggest these therapies in children.…”

Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study

“…In our study we also found that the duration of hospitalization in the medium dose subgroup of IVIG was longer than control group and no positive effects were obtained on duration of mechanical ventilation and mortality of patients. Many studies have shown that IVIG administration reduces mortality in patients with COVID-19, but increases hospitalization time instead of standard COVID-19 treatment [12,13].…”

Passive Immunity Should and Will Work for COVID-19 for Some Patients

“…The source of IVIG was not detailed (i.e., pre-or post-pandemic), and no data were provided on the presence of neutralizing or other anti-SARS-CoV-2 antibody. The benefits of IVIG are debatable, but several studies have not determined the pre-existing antiviral potency of the same [191][192][193][194][195]. Such studies do not preclude the potential benefit of IVIG in other niche situations, such as immune thrombocytopenia, ascending polyneuropathy, or multisystem inflammatory disorder attributable to COVID-19 [196][197][198].…”