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Original Research: Critical Care |

Hyperimmune IV Immunoglobulin TreatmentHyperimmune IV Immunoglobulin in Severe Influenza: A Multicenter Double-Blind Randomized Controlled Trial for Patients With Severe 2009 Influenza A(H1N1) Infection

Ivan F. N. Hung, MD; Kelvin K. W. To, MD; Cheuk-Kwong Lee, MD; Kar-Lung Lee, MD; Wing-Wa Yan, MD; Kenny Chan, MD; Wai-Ming Chan, MD; Chun-Wai Ngai, MD; Kin-Ip Law, MD; Fu-Loi Chow, MD; Raymond Liu, MD; Kang-Yiu Lai, MD; Candy C. Y. Lau, PhD; Shao-Haei Liu, MD; Kwok-Hung Chan, PhD; Che-Kit Lin, MD; Kwok-Yung Yuen, MD
Author and Funding Information

From the Carol Yu Center for Infection and Division of Infectious Diseases (Drs Hung, To, Lau, K.-H. Chan, and Yuen), State Key Laboratory of Emerging Infectious Diseases, the Department of Medicine (Dr Hung), and the Department of Anaesthesia and Intensive Care Unit (Drs W.-M. Chan and Ngai), Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; the Hong Kong Red Cross Blood Transfusion Service (Drs C.-K. Lee and Lin); the Department of Intensive Care Unit (Drs K.-L. Lee and Law), United Christian Hospital; the Department of Intensive Care Unit (Drs Yan and K. Chan), Pamela Youde Nethersole Eastern Hospital; the Department of Medicine and Geriatrics (Dr Chow), Intensive Care Unit, Caritas Medical Centre; the Department of Medicine (Dr R. Liu), Ruttonjee Hospital and Tang Shiu Kin Hospitals; the Department of Intensive Care Medicine (Dr Lai), Queen Elizabeth Hospital, Hong Kong; and the Department of Infection (Dr S.-H. Liu), Emergency and Contingency, Hospital Authority of Hong Kong Special Administrative Region, China.

Correspondence to: Kwok-Yung Yuen, MD, Carol Yu Center for Infection and Division of Infectious Diseases, The University of Hong Kong, Queen Mary Hospital, Pokfulam Rd, Hong Kong SAR, China; e-mail: kyyuen@hkucc.hku.hk


Funding/Support: This study was supported by the Research Fund for the Control of Infectious Diseases, the Providence Foundation Limited in memory of the late Lui Hac Minh, and the Hospital Authority.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):464-473. doi:10.1378/chest.12-2907
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Background:  Experience from influenza pandemics suggested that convalescent plasma treatment given within 4 to 5 days of symptom onset might be beneficial. However, robust treatment data are lacking.

Methods:  This is a multicenter, prospective, double-blind, randomized controlled trial. Convalescent plasma from patients who recovered from the 2009 pandemic influenza A(H1N1) (A[H1N1]) infection was fractionated to hyperimmune IV immunoglobulin (H-IVIG) by CSL Biotherapies (now BioCSL). Patients with severe A(H1N1) infection on standard antiviral treatment requiring intensive care and ventilatory support were randomized to receive H-IVIG or normal IV immunoglobulin manufactured before 2009 as control. Clinical outcome and adverse effects were compared.

Results:  Between 2010 and 2011, 35 patients were randomized to receive H-IVIG (17 patients) or IV immunoglobulin (18 patients). One defaulted patient was excluded from analysis. No adverse events related to treatment were reported. Baseline demographics and viral load before treatment were similar between the two groups. Serial respiratory viral load demonstrated that H-IVIG treatment was associated with significantly lower day 5 and 7 posttreatment viral load when compared with the control (P = .04 and P = .02, respectively). The initial serum cytokine level was significantly higher in the H-IVIG group but fell to a similar level 3 days after treatment. Subgroup multivariate analysis of the 22 patients who received treatment within 5 days of symptom onset demonstrated that H-IVIG treatment was the only factor that independently reduced mortality (OR, 0.14; 95% CI, 0.02-0.92; P = .04).

Conclusions:  Treatment of severe A(H1N1) infection with H-IVIG within 5 days of symptom onset was associated with a lower viral load and reduced mortality.

Trial Registry:  ClinialTrials.gov; No.: NCT01617317; URL: www.clinicaltrials.gov

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