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Article

Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus

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Anaesthesia and Intensive Care Department, University Hospital of Modena, 41124 Modena, Italy
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Anestesia and Intensive Care Department, University Hospital of Trieste, 34127 Trieste, Italy
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Infectious Disease Department, Torino SCU, Hospital of Asti, 14100 Asti, Italy
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Anaesthesia and Intensive Care Department, University Hospital of Ancona, 60127 Ancona, Italy
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Anaesthesia and Intensive Care Department, University Hospital of Pisa, 56124 Pisa, Italy
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Anaesthesia and Intensive Care Department, University Hospital of Milan, 20122 Milano, Italy
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Anaesthesia and Intensive Care Department, University Hospital of Foggia, 71122 Foggia, Italy
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Infectious Disease Department, University Hospital of Udine, 33100 Udine, Italy
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Infectious Disease Department, University Hospital of Bologna, 40126 Bologna, Italy
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Author to whom correspondence should be addressed.
Academic Editor: Jihad Mallat
J. Clin. Med. 2021, 10(16), 3500; https://doi.org/10.3390/jcm10163500
Received: 12 May 2021 / Revised: 29 July 2021 / Accepted: 3 August 2021 / Published: 8 August 2021
(This article belongs to the Collection Pulmonary and Critical Care Practice in the Pandemic of COVID-19)
Introduction: Adjunctive therapy with polyclonal intravenous immunoglobins (IVIg) is currently used for preventing or managing infections and sepsis, especially in immunocompromised patients. The pathobiology of COVID-19 and the mechanisms of action of Ig led to the consideration of this adjunctive therapy, including in patients with respiratory failure due to the SARS-CoV-2 infection. This manuscript reports the rationale, the available data and the results of a structured consensus on intravenous Ig therapy in patients with severe COVID-19. Methods: A panel of multidisciplinary experts defined the clinical phenotypes of COVID-19 patients with severe respiratory failure and, after literature review, voted for the agreement on the rationale and the potential role of IVIg therapy for each phenotype. Due to the scarce evidence available, a modified RAND/UCLA appropriateness method was used. Results: Three different phenotypes of COVID-19 patients with severe respiratory failure were identified: patients with an abrupt and dysregulated hyperinflammatory response (early phase), patients with suspected immune paralysis (late phase) and patients with sepsis due to a hospital-acquired superinfection (sepsis by bacterial superinfection). The rationale for intravenous Ig therapy in the early phase was considered uncertain whereas the panelists considered its use in the late phase and patients with sepsis/septic shock by bacterial superinfection appropriate. Conclusion: As with other immunotherapies, IVIg adjunctive therapy may have a potential role in the management of COVID-19 patients. The ongoing trials will clarify the appropriate target population and the true effectiveness. View Full-Text
Keywords: respiratory failure; COVID-19; intravenous immunoglobulin therapy respiratory failure; COVID-19; intravenous immunoglobulin therapy
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MDPI and ACS Style

Coloretti, I.; Berlot, G.; Busani, S.; De Rosa, F.G.; Donati, A.; Forfori, F.; Grasselli, G.; Mirabella, L.; Tascini, C.; Viale, P.; Girardis, M. Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus. J. Clin. Med. 2021, 10, 3500. https://doi.org/10.3390/jcm10163500

AMA Style

Coloretti I, Berlot G, Busani S, De Rosa FG, Donati A, Forfori F, Grasselli G, Mirabella L, Tascini C, Viale P, Girardis M. Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus. Journal of Clinical Medicine. 2021; 10(16):3500. https://doi.org/10.3390/jcm10163500

Chicago/Turabian Style

Coloretti, Irene, Giorgio Berlot, Stefano Busani, Francesco G. De Rosa, Abele Donati, Francesco Forfori, Giacomo Grasselli, Lucia Mirabella, Carlo Tascini, Pierluigi Viale, and Massimo Girardis. 2021. "Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus" Journal of Clinical Medicine 10, no. 16: 3500. https://doi.org/10.3390/jcm10163500

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