Thoughts on Intravenous Immune Globulin (IVIG) as long Covid therapy

Long Covid is like spraying petrol on the embers (or flame) of prior immune activation.

Every therapy showing benefit has a place in the treatment of long Covid, but understanding which patients are likely to respond is the challenge.

WHAT IS IVIG?

Intravenous immune globulin ("IVIG") is a product made up of antibodies that can be given intravenously (through a vein).

Antibodies are proteins that your body makes to help you fight infections. Each antibody made by your body is slightly different, because it fits like a lock and key to every foreign substance (such as a piece of a virus or bacterium) that gets into your body. Over the course of your life your body makes thousands of different antibodies as you are exposed to different infectious organisms that your body considers to be "foreign."

IVIG is prepared from the blood donated by thousands of people, to make a super-concentrated and very diverse collection of antibodies against many possible infectious organisms your body might encounter.

WHY DO I NEED IVIG?

IVIG is used primarily in two situations.

One reason you might need IVIG is if your body does not make enough antibodies. This is called "humoral immunodeficiency." The IVIG simply provides extra antibodies that your body cannot make on its own. The antibodies usually last for several weeks to months and help your body fight off a large variety of infections. If you are getting IVIG for this reason, you will need to get it on a regular schedule.

A second reason you might need IVIG is if your immune system has started attacking your own body by producing antibodies directed against your own cells.

Conditions in which this happens include:
●Destruction of your own blood platelets (known as immune thrombocytopenia [ITP]) ●Destruction of your own red blood cells (known as autoimmune hemolytic anemia [AIHA])
●Attack on your nervous system, such as nerves that control your breathing (in Guillain-Barré syndrome) or nerves that control sensation (for example, in chronic inflammatory demyelinating polyneuropathy [CIDP])

Experts believe IVIG prevents your immune system from destroying your own cells in these disorders.

Information taken from UpToDate here >

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Long-term high-dose immunoglobulin successfully treats Long COVID patients with pulmonary, neurologic, and cardiologic symptoms

We report nine patients suffering with Long COVID for 101 to 547 days. The patients’ ages ranged from 34 to 79 years—with five male and four female patients, respectively. All nine patients exhibited significant immune perturbations prior to treatment. One patient declined this treatment, and insurance support was not approved for two others. The other six have been treated, and all have had a significant to remarkable clinical benefit.

Conclusion: Long-term high-dose immunoglobulin therapy is an effective therapeutic option for treating patients with Long COVID.

Thompson, John S., et al. "Long term-high dose immunoglobulin successfully treats Long Covid patients with pulmonary, neurologic and cardiologic symptoms." Frontiers in Immunology 13: 8222.

Slides from the upcoming Long Covid Course

The slide above indicates the primary immune cells in the body. Not all are significantly involved in the long Covid symptom presentation.

The primary cells related to long Covid immunology are:

• Mast Cells

• Monocytes/Macrophages

• T-Cells

• B-Cells

• Platelets

In the context of these patients, it suggests the primary overlap would be B-cells and possibly macrophages. The IVIG could bring benefit but needs to be used in an appropriate context.