| Outcome |
Relative effect
(95% CI) |
Absolute effect
(95% CI)1 |
Certainty of the Evidence
(GRADE) |
Clinical improvement
D28 |
RR: 1.04
(0.98 - 1.11) |
33 more per 1000
(from 16 fewer to 90 more)
|
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, outcome measurement and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious
due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
|
| 3 trials
Polizzotto MN, 2022; Parikh D, 2021; Ali S, 2021
703 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
852 per 1,000
(803 - 909) |
Standard care/Placebo
819
per 1,000 |
|
Clinical improvement
D60 |
Outcome not yet measured or reported
|
|
WHO progression score (level 7 or above)
D28 |
RR: 0.57
(0.32 - 1.02) |
34 fewer per 1000
(from 54 fewer to 2 more)
|
Moderate certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious
Imprecision: Serious
due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
|
| 2 trials
Polizzotto MN, 2022; Ali S, 2021
643 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
45 per 1,000
(25 - 81) |
Standard care/Placebo
79
per 1,000 |
|
WHO progression score (level 7 or above)
D60 |
Outcome not yet measured or reported
|
|
All-cause mortality
D28 |
RR: 0.61
(0.34 - 1.09) |
34 fewer per 1000
(from 58 fewer to 8 more)
|
Moderate certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious
Imprecision: Serious
due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
|
| 3 trials
Polizzotto MN, 2022; Parikh D, 2021; Ali S, 2021
703 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
53 per 1,000
(30 - 95) |
Standard care/Placebo
87
per 1,000 |
|
All-cause mortality
D60 |
Outcome not yet measured or reported
|
|
Viral negative conversion
D7 |
RR: 1.00
(0.70 - 1.43) |
0 fewer per 1000
(from 200 fewer to 287 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
Parikh D, 2021
60 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
667 per 1,000
(467 - 953) |
Standard care/Placebo
667
per 1,000 |
|
Adverse events
|
RR: 1.03
(0.66 - 1.59) |
7 more per 1000
(from 77 fewer to 133 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: 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
Parikh D, 2021; Ali S, 2021
110 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
232 per 1,000
(149 - 358) |
Standard care/Placebo
225
per 1,000 |
|
Serious adverse events
|
RR: 0.88
(0.48 - 1.60) |
8 fewer per 1000
(from 34 fewer to 39 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
|
| 2 trials
Polozzotto MN, 2022; Parikh D, 2021
653 participants
|
|
Hyperimmune anti-COVID-19 Intravenous Immunoglobulin
57 per 1,000
(31 - 104) |
Standard care/Placebo
65
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
