Rapid Evidence Review: Clinical evidence for the use of intravenous immunoglobulin in the treatment of COVID-19 [v2.0]
| dc.contributor.author | National Centre for Pharmacoeconomics | |
| dc.contributor.author | COVID-19 Evidence Review Group for Medicines | |
| dc.date.accessioned | 2020-08-05T15:43:30Z | |
| dc.date.available | 2020-08-05T15:43:30Z | |
| dc.date.issued | 2020-05-14 | |
| dc.identifier.uri | http://hdl.handle.net/10147/628016 | |
| dc.description | Intravenous immunoglobulin is a pooled preparation of normal human Immunoglobulin G, used as replacement therapy for humoral immune disorders and for specified inflammatory diseases for patients with humoral immunodeficiency and certain neuroinflammatory conditions. Clinical opinion highlighted that pooled IVIG products will not contain specific antibodies to SARS-CoV2; any potential effect will be non-specific. There is no robust evidence from randomised controlled, comparative clinical trials supporting the use of IVIG in patients with COVID-19. A number of descriptive, observational studies were retrieved following a literature search. Four studies specifically evaluated the role of IVIG in patients with COVID-19. However, given the observational, single-armed, open-label design there is considerable bias in the estimates of benefit derived from IVIG. In several other studies, IVIG was a component of a multiple treatment strategy and it is therefore highly uncertain which treatment was beneficial. A number of published guidelines have recently included a reference to the use of IVIG in patients with COVID-19, and recommendations range from explicit advice against its routine use due to lack of evidence on its benefit, to use in clinical trials alone or for its use to be led by clinical expert input. Other than its broad use as an anti-inflammatory agent at high doses, there is limited rationale for the use of IVIG in COVID-19. The prothrombotic effect of IVIG may be a cause for concern in patients with severe COVID-19 who may have elevated D-dimer levels. Whilst this agent is considered, in some circumstances, as an adjunctive treatment in sepsis, it is not routine treatment. There is a risk that use of IVIG as a rescue therapy would compromise the supply of IVIG to patients established on it for conditions where benefit has been demonstrated. Clinical opinion advises that IVIG should not be used without input from the multidisciplinary team and ideally, and any use should be restricted to a clinical trial setting. Conclusion Like many treatments proposed to treat this condition, intravenous immunoglobulin is unlicensed for the treatment of COVID-19. This Rapid Evidence Review finds that there is currently insufficient evidence to support the use of IVIG in the management of patients with COVID-19. In addition, both the European Society of Intensive Care medicine/Society of Critical Care Medicine and the National Institute for Health guidelines advise against the use of IVIG in the treatment of COVID-19. | en_US |
| dc.language.iso | en | en_US |
| dc.publisher | National Centre for Pharmacoeconomics | en_US |
| dc.subject | CORONAVIRUS | en_US |
| dc.subject | COVID-19 | en_US |
| dc.subject | IMMUNOTHERAPY | en_US |
| dc.subject | MEDICINES | en_US |
| dc.subject | DRUG THERAPY | en_US |
| dc.title | Rapid Evidence Review: Clinical evidence for the use of intravenous immunoglobulin in the treatment of COVID-19 [v2.0] | en_US |
| dc.type | Other | en_US |
| refterms.dateFOA | 2020-08-05T15:43:32Z |
