Table 1.
Characteristics of the studies included in the meta‑analysis.
| Frist author, year | Type of study | country | Type of disease | Sample (male) |
Treatment |
Summary | ||
|---|---|---|---|---|---|---|---|---|
| intervention | control | intervention | control | |||||
| Gharebaghi 2020 | RCT | Iran | Severe; A PCR-confirmed COVID-19 diagnosis, involvement of > than 30% of both lungs (ground-glass opacity) in high-resolution computed tomography (HRCT) (confirmed by two radiologists), O2saturation(satO2) of < 90%, and a lack of adequate response to initial treatment including at least both one antiviral and one chloroquine-class drug. |
30 (21) | 29 (20) | IVIG (human) flebo gamma 5% DIF GRIFOLS, four vials of 5 gm5 IVIG daily for three consecutive days; receive the same treatments as were introduced initially | Placebo; receive the same treatments as were introduced initially | 1. Improve their clinical outcome including serum creatinine, white blood cell which were higher in the control group 2. Reduce mortality rate. 3. Longer duration of hospitalization in the treatment group. |
| Sakoulas 2020 | RCT | USA | Severe: SpO2 < 96% on > 4 L O2 by nasal cannula APACHE II: (7, 7.5) |
16(10) | 17(10) | IVIG 0.5 g/Kg for 3 days and SOC; All received methylprednisolone | Receive any treatment not part of a RCT at the time of enrollment | 1. Lower rate of mechanical ventilation; 2.Shorter median hospital length of stay; 3. Shorter median ICU stay; 4. Greater improvement in PaO2/FiO2 at 7 days. |
| Tabarsi 2021 | RCT | Iran | Severe Breaths/min ≥ 30, SpO2 ≤ 93% PaO2/ FiO2 ≤ 300 mmHg. |
52(40) | 32(25) | 400 mg/kg daily for three doses IVIG, premedicated with 500 mg Acetaminophen, 100 mg Hydrocortisone, and 25 mg Diphenhydramine 30 min before the injection. SOC: oxygen and fluid support, lopinavir/ ritonavir (200/50 mg, Hetero labs), two tablets twice a day, and hydroxychloroquine (Tehran-Daru) 200 mg two times daily. |
SOC | 1. No significant difference between the two groups in terms of mortality rate and the need for mechanical ventilation; 2. The length of hospital stay was lower for the control group than that of the intervention group; 3. Positive relationship between the time from hospital admission to IVIG initiation and the length of stay in the hospital and ICU among the survivors. |
| Raman 2021 | RCT | India | Non-severe: Pneumonia were defined as: body temperature ≥ 38.0℃ or PaO2/ FiO2 100–300 mmHg or respiratory rate > 24/min and oxygen saturation 90–93% on room air or lung involvement confirmed with chest X-ray. |
50 (14) | 50 (19) | daily received immunoglobulin 0.4 g/kg body weight for 5 days SOC: Azithromycin; Lopinavir/ritonavir; Piperacillin + Tazobactam; Acetaminophen and Pantocid. |
SOC | 1. Reduce the number of days to clinical improvement, 2. Reduce the duration of use of mechanical ventilation; duration of hospitalization and length of stay in intensive coronary care unit from day 0 to 28. 3. Increased the proportion of patients with negative RT-PCR on day 14. |
| Shao 2020 | RCS | China | Severe , andcritical ill | 174 (112) | 151(77) | NM | NM | 1. The total duration of disease was longer in the IVIG group 2. Only in patients with critical type, IVIG could significantly reduce the 28-day mortality, decrease the inflammatory response and improve some organ functions; 3.The application of IVIG in the early stage (admission ≤ 7 days) with a high dose (>15 g per day) exhibited significant reduction in 60-day mortality in the critical-type patients. |
| Esen 2021 | RCS | Turkey | Critical (a) respiratory rate > 30/min, (b) signs of dyspnea and respiratory distress. (c)SpO2 < 90% and PaO2 < 70 mmHg, despite nasal oxygen support of > 5 L/min. (d) PaO2/FiO2 < 300 (mild acute respiratory distress syndrome (ARDS). |
51 (37) | 42 (31) | a dose 30 g/day IVIG for five consecutive days SOC: hydroxychloroquine (800 mg loading dose, LD; 400 mg/day maintenance dose, MD for 5 days); favipiravir (3200 mg LD; 1200 mg/day MD for 5 days), azithromycin (500 mg LD; 250 mg/day MD for 5 days), oseltamivir (150 mg/day for 5 days), tocilizumab or anakinra depending on inflammatory markers, methylprednisolone (200 mg/day), high dose vasopressors in case of septic shock and vitamin C (6 g/day i.v. for 7 days). |
SOC | IVIG group significantly prolonged median survival time and reduced plasma levels of C-reactive protein. |
| Huang 2021 | RCS | China | Non-severe; (1) Respiratory distress, respiratory rates ≥ 30/min; (2) Pulse oxygen saturation ≤ 93% in the resting state; (3) Oxygenation index ≤ 300 mmHg; (4) Require mechanical ventilation; (5) Shock; (6) Combined with other organ failures and needed treatment in ICU. |
45(23) | 90(50) | IVIG SOC: Corticosteroids, Chinese Medicine, Hydroxychloroquine, Thymosin α, Arbidol, Lopinavir/Ritonavir |
SOC | In non-severe patients with COVID-19, no benefit was observed with IVIG therapy beyond standard therapy. |
Note: IVIG: intravenous immunoglobulin; SOC: standard of care; NM: not mention.