Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Intravenous Immunoglobulin vs Standard care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022.

Studies included but not extracted/included in the analysis: NCT04480424 results posted on clinicaltrials.gov

Hospitalized patients

Forest plots
(last update: 2022-04-29)

Summary of findings
(last update: 2022-09-27)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Intravenous Immunoglobulin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.14 (0.61 - 2.13)	40 more per 1000 (from 112 fewer to 325 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviations from intended interventions, outcome measurement and selection of reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:60.5% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Sakoulas G, 2020; Mazeraud A, 2021 180 participants		Intravenous Immunoglobulin 327 per 1,000 (175 - 612)	Standard care/Placebo 287 per 1,000
Clinical improvement D60	RR: 0.97 (0.70 - 1.35)	15 fewer per 1000 (from 152 fewer to 177 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Mazeraud A, 2021 146 participants		Intravenous Immunoglobulin 491 per 1,000 (355 - 684)	Standard care/Placebo 506 per 1,000
WHO progression score (level 7 or above) D28	RR: 0.74 (0.21 - 2.05)	141 fewer per 1000 (from 429 fewer to 570 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with adequate randomization, deviation from intended intervention, and selection of the reported results, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Sakoulas G, 2020; Mazeraud A, 2021 180 participants		Intravenous Immunoglobulin 401 per 1,000 (114 - 1000)	Standard care/Placebo 543 per 1,000
WHO progression score (level 7 or above) D60	RR: 0.89 (0.61 - 1.30)	50 fewer per 1000 (from 177 fewer to 136 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Mazeraud A, 2021 146 participants		Intravenous Immunoglobulin 405 per 1,000 (277 - 591)	Standard care/Placebo 455 per 1,000
All-cause mortality D28	RR: 1.13 (0.80 - 1.60)	28 more per 1000 (from 43 fewer to 130 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Sakoulas G, 2020; Tabarsi P, 2020; Raman RS, 2021; Mazeraud A, 2021 364 participants		Intravenous Immunoglobulin 244 per 1,000 (173 - 345)	Standard care/Placebo 216 per 1,000
All-cause mortality D60	RR: 1.01 (0.68 - 1.50)	4 more per 1000 (from 129 fewer to 201 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Mazeraud A, 2021 146 participants		Intravenous Immunoglobulin 407 per 1,000 (274 - 604)	Standard care/Placebo 403 per 1,000
Viral negative conversion D7	RR: 3.83 (2.33 - 6.32)	679 more per 1000 (from 319 more to 1000 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention and selection of reported results Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Raman RS, 2021 100 participants		Intravenous Immunoglobulin 919 per 1,000 (559 - 1000)	Standard care/Placebo 240 per 1,000
Adverse events	RR: 1.07 (0.88 - 1.30)	36 more per 1000 (from 62 fewer to 156 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with adequate randomization, deviations from intended interventions, outcome measurement and selection of reported results, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Sakoulas G, 2020; Raman RS, 2021; Mazeraud A, 2021 246 participants		Intravenous Immunoglobulin 556 per 1,000 (457 - 676)	Standard care/Placebo 520 per 1,000
Serious adverse events	RR: 0.93 (0.27 - 3.21)	9 fewer per 1000 (from 96 fewer to 292 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Raman RS, 2021; Sakoulas G, 2020; Mazeraud A, 2021 280 participants		Intravenous Immunoglobulin 123 per 1,000 (36 - 424)	Standard care/Placebo 132 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

To access all information :

click here for Hospitalized patients

You can print it as a pdf. You can also click on each forest plot with your right mouse button and download.

Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=35

Back to your research

Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04350580; EudraCT2020-001570-30 ICAR Mazeraud A, Lancet Respir Med, 2021 Full text Commentary Commentary	Public/non profit	Intravenous Immunoglobulin	Placebo	RCT	Patients with confirmed COVID-19 (critical) admitted to 27 centers in France.	N=146	Low Details	Full description
CTRI/2020/06/026222 Raman RS, J Infect Dis, 2021 Full text Commentary	Private	Intravenous Immunoglobulin	Standard care	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to four centers in India	N=100	Some concerns Details	Full description
IRCT20151227025726N20 Tabarsi P, Int Immunopharmacol, 2020 Full text Commentary	Public/non profit	Intravenous Immunoglobulin	Standard care	RCT	Patients with COVID-19 (severe) admitted to a single center in Iran	N=84	Some concerns Details	Full description
IRCT20200501047259N1 Gharebaghi N, BMC Infect Dis, 2020 Full text Commentary	Public/non profit	Intravenous Immunoglobulin	Placebo	RCT	Patients with confirmed COVID-19 (severe) admitted to a single center in Iran	N=59	N/A	Full description
NCT04411667 Sakoulas G, Crit Care Expl, 2020 Full text Commentary	drug donation only	Intravenous Immunoglobulin	Standard care	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to 2 centers in USA.	N=34	Some concerns Details	Full description