Can Immunotherapy for Long Covid Help? IVIG, Rituximab and Monoclonal Antibodies

by LCJ Team, posted in Managing Long Covid

Key Takeaways

  • Researchers are investigating whether immunotherapy for Long Covid could help a small group of patients with immune dysregulation.
  • Treatments such as IVIG, rituximab and monoclonal antibodies are not routine Long COVID treatments and remain experimental.
  • Early studies and case reports have shown encouraging results in some carefully selected patients, but the evidence is still limited.
  • Long COVID appears to involve several different biological processes, which may explain why one treatment is unlikely to help everyone.
  • At present, these therapies should only be considered under specialist supervision or as part of clinical research.

Why Are People Suddenly Talking About IVIG and Monoclonal Antibodies?

Spend a few minutes in almost any Long COVID support group and you’ll eventually see the same conversation.

“Has anyone tried IVIG?” “What about rituximab?””Could monoclonal antibodies finally be the answer?”

The replies are rarely straightforward.Someone says a treatment changed their life.Someone else says it made no difference.Another person explains they were told they didn’t qualify, while others point out the treatment costs tens of thousands of pounds.It’s enough to leave anyone wondering what is actually true.Are these treatments genuinely promising? Or are they simply the latest source of hope in a condition where effective treatments remain frustratingly limited?The honest answer is somewhere in the middle.

Researchers are taking immunotherapies seriously, but not because they have already been proven to work. They are being studied because, over the last few years, our understanding of Long COVID has changed dramatically.Instead of asking only how to manage symptoms, researchers are now trying to understand why those symptoms continue long after the initial infection has gone.

It Started With A Simple Question: Can Immunotherapy for Long Covid Help?

When Long COVID first emerged, many doctors expected recovery to follow a familiar pattern.Like most viral illnesses, symptoms would gradually improve, energy would slowly return and life would eventually return to normal.For many people, that’s exactly what happened. But for millions of others, it didn’t. Weeks became months.Months became years.Instead of recovering, people developed a bewildering combination of symptoms affecting almost every system in the body.

Fatigue that didn’t improve with rest. Brain fog that made simple conversations difficult.A racing heart after standing. Breathlessness despite normal lung tests. Food intolerances.Temperature regulation problems.Post-exertional malaise.

The question was no longer whether Long COVID existed. It was why one infection could leave behind such a wide range of seemingly unrelated symptoms.The more researchers looked, the more they began to notice one possible connection. The immune system.

Why Did Researchers Start Looking At The Immune System?

Your immune system has one important job. It recognises danger, deals with it and then settles back down again. Most of the time, that’s exactly what happens. After a viral infection, the immune response gradually switches off and the body begins repairing any damage left behind. Long COVID doesn’t always seem to follow that pattern.

Instead, some studies have found evidence that parts of the immune system remain altered months, and sometimes years, after the initial infection.Researchers have reported changes in inflammatory signalling, differences in B-cell and T-cell function, evidence of immune activation in some patients and, in certain studies, autoantibodies that may interfere with normal biological processes.

None of these findings explain every case of Long COVID. Some people show one pattern.Others show another.Many show none of them at all.Rather than finding a single cause, researchers have uncovered a much more complicated picture.

Long COVID is unlikely to be one disease. And if that is true, it is unlikely to have one treatment.

So Does That Mean Long COVID Is An Autoimmune Disease?

Not necessarily. This is one of the biggest misunderstandings surrounding Long COVID research.

As soon as people hear that doctors are investigating treatments used for autoimmune diseases, it’s easy to assume Long COVID must also be autoimmune. The reality is far more complicated. Some people with Long COVID go on to develop recognised autoimmune diseases.Some have laboratory findings that suggest immune dysregulation without meeting the criteria for an autoimmune diagnosis.

Others show very little evidence of either.Current research suggests that immune dysfunction may be one important piece of the puzzle but probably not the whole puzzle. That’s why researchers increasingly describe Long COVID as a collection of different biological phenotypes rather than a single condition.

For one person, the immune system may be playing a major role. For another, autonomic dysfunction, viral persistence, metabolic changes or problems affecting the small blood vessels may be more important.

Understanding those differences is becoming one of the biggest challenges in Long COVID research.And it’s also the reason why treatments like IVIG or rituximab are unlikely to be suitable for everyone.

Which Immune Treatments Are Researchers Studying?

Once researchers began asking whether the immune system might be driving Long COVID in some people, another question naturally followed.

Could treatments already used for immune diseases help?

The answer isn’t straightforward. Several immune therapies are now being investigated, but they are all trying to answer the same question:

If the immune system is contributing to Long COVID, can changing the immune response improve symptoms?

At the moment, no treatment has been proven to do this consistently. Some have produced encouraging early results. Others have shown little benefit. Many are still being studied.

IVIG: Resetting an Overactive Immune System?

IVIG, or intravenous immunoglobulin, is one of the treatments that patients ask about most often. It isn’t a new drug. Doctors have used IVIG for decades to treat certain autoimmune diseases, immune deficiencies and neurological conditions where the immune system is no longer behaving normally.

It contains antibodies collected from thousands of healthy donors and works by changing how the immune system responds rather than simply suppressing it. Exactly how IVIG works is surprisingly complex.

Depending on the condition, it may calm harmful immune activity, neutralise abnormal antibodies or help restore a healthier balance between different parts of the immune system. Because some people with Long COVID appear to have immune abnormalities, researchers have wondered whether IVIG could have a similar effect here.

Small case reports and observational studies have described improvements in some carefully selected patients, particularly those with significant autonomic dysfunction, small fibre neuropathy or features suggesting immune-mediated neurological disease.These reports are encouraging.

But they are also exactly thatsmall reports. They don’t tell us whether IVIG helps most people with Long COVID, or only a small group whose illness is driven by a particular biological process.

That is one of the questions clinical trials are now trying to answer.

Rituximab: Treating the Immune Cells Instead of the Symptoms

Another treatment that is often discussed is rituximab. Unlike IVIG, rituximab works by reducing a specific group of immune cells called B cells. These cells normally help the body fight infection by producing antibodies.In autoimmune diseases, however, B cells can sometimes produce antibodies that mistakenly target the body’s own tissues.

Researchers became interested in rituximab because some studies have identified autoantibodies in subsets of people with Long COVID.If those antibodies are contributing to symptoms, reducing the B cells that produce them might, in theory, improve the illness.It’s a reasonable scientific question.

The challenge is that we still don’t know how often those antibodies are truly driving Long COVID, whether they are causing disease or simply appearing alongside it, or which patients might benefit from treatment.At the moment, rituximab remains an experimental approach for Long COVID rather than an established therapy.

What About Monoclonal Antibodies?

The phrase monoclonal antibodies actually describes a large family of medicines rather than one specific treatment. Some were designed to neutralise the coronavirus itself during the early stages of infection.Others target parts of the immune system involved in inflammation or autoimmune disease.That distinction is important.

Treatments such as Evusheld, Pemgarda and Sipavibart were developed to prevent or reduce acute COVID-19 infection in people whose immune systems could not respond normally. Researchers are now exploring whether some of these medicines might also help certain people with Long COVID, particularly if viral persistence turns out to play a role.

At present, however, there is no convincing evidence that antiviral monoclonal antibodies should be used routinely to treat Long COVID outside clinical research.Their role remains uncertain, and studies are still ongoing.

Why Do Some People Improve While Others Don’t?

This is probably the most important question of all. If you’ve spent time reading patient stories, you’ve probably noticed something confusing. One person describes dramatic improvement after an immune treatment.Another reports no change whatsoever.

How can both be true? The simplest explanation is that Long COVID probably isn’t one illness.

Imagine trying to treat every type of headache with the same medicine. Some headaches are caused by dehydration. Others by migraine. Others by infection. The symptoms may look similar, but the underlying biology is completely different.

Long COVID appears to be much the same. One person’s symptoms may be driven largely by autonomic dysfunction. Another’s by immune dysregulation. Someone else may have ongoing tissue injury, metabolic changes or a combination of several different processes.

If that is true, it would explain why one treatment is unlikely to help everyone and why identifying the right patients is becoming just as important as developing the treatments themselves.

Why Aren’t These Treatments Available More Widely?

When people read about IVIG or monoclonal antibodies online, it’s natural to wonder why they aren’t routinely offered. The answer isn’t because doctors don’t believe Long COVID is real.It’s because medicine has to answer two questions before a treatment becomes standard care.

Does it work? And equally importantly:

Who does it work for? At the moment, the evidence simply isn’t strong enough to answer those questions with confidence.

Most studies have involved relatively small numbers of patients, often without control groups, and many have focused on highly selected individuals rather than the wider Long COVID population. That makes it difficult to know whether improvements were caused by the treatment itself, by natural recovery, or by selecting patients whose biology made them more likely to respond.Until larger, well-designed clinical trials are completed, most immune therapies remain experimental for Long COVID.

It’s Also About Safety

One of the easiest mistakes to make is assuming that if a treatment targets the immune system, it must be worth trying. Unfortunately, it’s rarely that simple.Immune therapies can have significant side effects. Depending on the treatment, these may include infusion reactions, increased susceptibility to infection, allergic responses, blood clots or suppression of normal immune function.They are also extremely expensive.Some treatments cost many thousands of pounds for a single course, while others can cost tens of thousands each year.

That means doctors have to be confident that the potential benefits outweigh the risks before recommending them.

For now, most specialists agree that these treatments should be reserved for carefully selected patients, ideally within specialist centres or clinical trials, while the evidence continues to grow.

So, Where Does This Leave Us?

If you’ve come across stories online about people improving after IVIG, rituximab or monoclonal antibodies, it’s understandable to wonder whether you’ve finally found the answer. The reality is more complicated than that.These treatments are not based on wishful thinking. Researchers have genuine scientific reasons for investigating them. Studies over the past few years have strengthened the idea that immune dysregulation plays an important role in at least some people with Long COVID. That has made immunotherapy one of the most active and promising areas of current research. 

At the same time, promise is not proof. Some patients appear to improve.Others experience little or no benefit.

At present, researchers cannot reliably predict who is most likely to respond, which is exactly why larger clinical trials are now taking place around the world. 

The biggest challenge is no longer asking whether immunotherapy works. It’s understanding who it works for, when it should be used, and why.

Those answers are likely to shape the next generation of Long COVID treatments.

Frequently Asked Questions

Can immunotherapy cure Long COVID?

Not at the moment.
No immunotherapy has been shown to cure Long COVID. Some early studies and case reports suggest that carefully selected patients may improve, but the evidence is still limited and responses vary considerably from person to person.

Which patients might benefit from immunotherapy?

That’s one of the biggest unanswered questions.
Researchers believe immune-targeted treatments are unlikely to help everyone with Long COVID. Instead, they may benefit a smaller group of patients whose illness is driven by immune dysregulation, autoimmune processes or specific neurological complications.
At present, there is no validated test that can reliably identify who will respond.

Why aren’t IVIG or rituximab routinely available for Long COVID?

Because medicine needs more than encouraging patient stories before recommending a treatment.
Before any therapy becomes routine, doctors need good evidence that it works, that its benefits outweigh its risks, and that they can identify the patients most likely to benefit.
For Long COVID, we are not there yet.
Most published studies have been small, observational or involved carefully selected patients. Larger randomised clinical trials are now underway, but until those results are available, most immunotherapies remain experimental for Long COVID. 

Is cost one of the reasons these treatments are difficult to access?

Yes but cost is only part of the story.
Treatments such as IVIG and monoclonal antibodies can cost many thousands of pounds for a single course, while some biological therapies cost tens of thousands of pounds each year.
Healthcare systems like the NHS have to consider not only whether a treatment appears promising, but whether there is enough high-quality evidence to justify funding it safely and fairly.
Without strong clinical trial data showing who benefits, offering expensive treatments routinely could expose some patients to unnecessary risks while providing little or no benefit.
This is why access is currently limited to specialist centres, individual clinical decisions or research studies in most countries.

Are monoclonal antibodies such as Pemgarda, Evusheld or Sipavibart used for Long COVID?

Not routinely.
These medicines were originally developed to prevent or treat acute COVID-19 infection in people at high risk.
Researchers are investigating whether some monoclonal antibodies might also help certain groups of people with Long COVID, particularly if viral persistence plays a role. However, there is currently insufficient evidence to recommend them as standard treatment outside clinical trials. 

Should I try to access immunotherapy privately?

This is a decision that should only be made after careful discussion with an experienced specialist.
Some private clinics offer immune-targeted therapies for Long COVID, but these treatments remain expensive, carry potential risks and are supported by limited evidence.
The fact that a treatment is available privately does not necessarily mean it has been proven to work.
For most people, participation in well-designed clinical research remains the safest way of helping answer these important questions while receiving careful medical supervision.

Related Resources

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Sources and Evidence

This article is based on current clinical guidance, peer-reviewed research and ongoing clinical trials investigating immune dysfunction and immunotherapy in Long COVID.

Key sources include:

  • NICE. COVID-19 rapid guideline: Managing the long-term effects of COVID-19 (NG188).
  • Communications Medicine. Current status and future perspectives on the mechanistic and pathophysiological understanding of Long COVID (2025).
  • Frontiers in Cellular and Infection Microbiology. Immunotherapies for POTS, autonomic disorders and Long COVID: Current state and future direction (2025).
  • Reviews of ongoing clinical trials investigating IVIG, rituximab, immunoadsorption, baricitinib and monoclonal antibodies in Long COVID. 

Research into Long COVID is evolving rapidly. This article reflects the evidence available at the time of review and will be updated as new high-quality studies become available.

How This Article Was Prepared

This article was written and reviewed by the LongCovidJourney editorial team using current clinical guidance, peer-reviewed research and evidence from ongoing clinical trials. Where evidence is well established, we say so.Where uncertainty remains, we say that too. Our goal is not to offer false hope or unnecessary pessimism, but to explain what researchers know today, what they are still trying to understand, and what that may mean for people living with Long COVID.

Last evidence review: July 2026

Disclaimer

This article is for educational purposes only and should not replace personalised medical advice.Immunotherapies such as IVIG, rituximab and monoclonal antibodies carry significant risks and are not routinely recommended for Long COVID outside specialist care or clinical research.Always discuss potential treatments with a qualified healthcare professional before making decisions about you

One thought on “Can Immunotherapy for Long Covid Help? IVIG, Rituximab and Monoclonal Antibodies”

  1. This immune-subset framing is exactly why Long Covid is so hard for patients to explain without sounding scattered. The new autoantibody work adds weight to the idea that some people are not just dealing with deconditioning or anxiety; their immune system may still be misfiring. I like the caution here around selection and risk. For patients, the practical gap is often having a framework for organizing symptoms, triggers, diet, pacing, supplements, and recovery-support questions without turning it into a miracle protocol.

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