Polyclonal immunoglobulins for COVID-19 pre-exposure prophylaxis in immunocompromised patients

Daniele Focosi; Massimo Franchini

doi:10.1016/j.transci.2023.103648

Polyclonal immunoglobulins for COVID-19 pre-exposure prophylaxis in immunocompromised patients

Transfus Apher Sci. 2023 Jun;62(3):103648. doi: 10.1016/j.transci.2023.103648. Epub 2023 Jan 31.

Authors

Daniele Focosi¹, Massimo Franchini²

Affiliations

¹ North-Western Tuscany Blood Bank, Pisa University Hospital, 56100 Pisa, Italy. Electronic address: daniele.focosi@gmail.com.
² Division of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy. Electronic address: massimo.franchini@asst-mantova.it.

Abstract

Immunocompromised patients remain at high risk of COVID-19 morbidity and mortality. After recent Omicron sublineages gained full resistance to Evusheld™, they are left without effective pre-exposure prophylaxis. We review here arguments to support the growing role of regular immunoglobulin (IG) infusions at protecting against COVID-19. Since there is evidence for neutralizing antibody titers approaching the ones seen in hyperimmune sera, and since some categories of patients at risk for COVID-19 progression are already under preexposure prophylaxis with IG, this cost-effective strategy should be urgently investigated in randomized clinical trials. Surveys of anti-Spike antibody levels in current plasma donations are urgent to forecast the potency of future IG batches.

Keywords: COVID-19; Polyclonal immunoglobulins.

Publication types

Review
Letter

MeSH terms

Antibodies
Antibodies, Viral
COVID-19* / prevention & control
Humans
Immunocompromised Host
Pre-Exposure Prophylaxis*

Substances

Antibodies
Antibodies, Viral