Treatment of Multisystem Inflammatory Syndrome in Children

Abstract

Background Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. Methods We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. Results Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. Conclusions We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue. (Funded by the European Union’s Horizon 2020 Program and others; BATS ISRCTN number, ISRCTN69546370 .)

Current Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome in Children

“…Several retrospective reviews support the clinical impression that myocardial function normalizes more quickly in children who receive corticosteroid with IVIG [ 65 , 66 , 67 •]. A single study suggesting a lack of benefit of corticosteroids in MIS-C included a subset of patients who did not meet a standard MIS-C case definition and were negative for SARS-CoV-2 antibody, making a diagnosis of SARS-CoV-2-related illness unlikely in these patients and complicating interpretation of the results [ 68 ]. The optimal dose of corticosteroid for MIS-C remains unknown, but in two studies, doses in the 1–2-mg/kg/day range were used [ 65 , 66 ]; many centers use a tapering dose regimen over a 2–3-week period.…”

COVID-19 Vaccinations: A Comprehensive Review of Their Safety and Efficacy in Special Populations

“…There is no definitive cure to date. The consequences of being infected with COVID-19 can be multi-faceted, such as multisystem inflammatory syndrome in children, acute multi-organ failure in adults, and long COVID-19 syndrome in all recoverees [2][3][4][5]. Global vaccination programs and multiple preventive measures are the most effective ways to curb rapid transmission.…”

Are we sure that the neurological impact of COVID 19 in childhood has not been underestimated?

“…Presently, it is known that, even if less frequently than in adults, children can develop a severe COVID-19. At higher risk are subjects with severe underlying medical conditions, younger children and those that develop the so-called multisystem inflammatory syndrome (MIS-C) [ 1 , 6 ]. Moreover, the review of the clinical picture of pediatric COVID-19 has shown that its impact extends beyond the pulmonary morbidity and mortality of the disease.…”