Why the application of IVIG could be beneficial in patients with COVID-19

- Mazeraud A
- James M
- Mancusi RL
- et al.
We would like to address the reasons for the lack of effect that were not discussed in the article by Mazeraud and colleagues.
- Guell E
- Martin-Fernandez M.
- From the Torre M
- et al.
- Werdan K
- Pilz G
- Bujdoso O
- et al.
,
- Brocklehurst P
- Farrell B
- King A
- et al.
On the other hand, the first published data on the IgM-enriched IVIG solution are encouraging.
- World T
- Dellinger PR
- H belt
- et al.
,
- Krautz C
- Maier SL
- Brunner M
- et al.
,
- Justel M
- L-Companies
- Almansa R
- et al.
From a pathophysiological point of view, it would be possible that beneficial effects of IVIG substitution were observed only in these patients, but not in those with normal or elevated basal immunoglobulin levels.
- World T
- Dellinger PR
- H belt
- et al.
In this double-blind study, in addition to standard care, an IgM-enriched IVIG solution (42 mg IgM/kg per day) was applied. The combined primary endpoint of ventilator-free days and all-cause mortality at 28 days was not statistically different in the intent-to-treat cohort (22.2% vs. 27 8%). More importantly, in a predefined subgroup analysis of patients with high level of inflammation (C-reactive protein levels greater than 70 mg/L), low serum IgM levels (less than 0.8 g /L) or both, mortality was significantly reduced, with the highest level of mortality reduction in the cohort with high C-reactive protein concentrations and low IgM levels.
Therefore, contrary to the conclusion of Mazeraud and colleagues, we hypothesize that the application of IVIG in patients with COVID-19 could be beneficial if a specific IgM-enriched IVIG solution is applied in patients with COVID-19. patients with low levels of IgM and a high level of inflammation.
DKM received conference fees from Biotest. All other authors declare no competing interests.
The references
- 1.
Intravenous immunoglobulins in patients with moderate to severe acute respiratory distress syndrome (ICAR) associated with COVID-19: a multicentre, double-blind, placebo-controlled phase 3 trial.
Respir Med lancet. 2022; ten: 158-166
- 2.
Impact of the number of lymphocytes and neutrophils on the risk of mortality in severe community-acquired pneumonia with or without septic shock.
J Clin Med. 2019; 8: 754
- 3.
Score-based immunoglobulin G therapy in patients with sepsis: the SBITS study.
Crit Care Med. 2007; 35: 2693-2701
- 4.
Treatment of neonatal sepsis with intravenous immunoglobulins.
N Engl J Med. 2011; 365: 1201-1211
- 5.
Efficacy and safety of trimodulin, a new polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study).
Intensive Care Med. 2018; 44: 438-448
- 6.
Immunoglobulin M: an ancient antiviral weapon – rediscovered.
Immunol before. 2020; 111943
- seven.
Reduced levels of circulating B cells and plasma IgM are associated with decreased survival in sepsis – a meta-analysis.
Critical care J. 2018; 45: 71-75
- 8.
Plasma IgM levels predict the outcome of severe pandemic influenza.
J Clin Virol. 2013; 58: 564-567
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