Potentially effective drugs for the treatment of COVID-19 or MIS-C in children: a systematic review

Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. Lanzhou University Institute of Health Data Science, Lanzhou, China. School of Public Health, Lanzhou University, Lanzhou, China. Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China. National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. Chongqing Key Laboratory of Pediatrics, Chongqing, China. The First School of Clinical Medicine, Lanzhou University, Lanzhou, China. Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain. Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China. emliu186@126.com. National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China. emliu186@126.com. Chongqing Key Laboratory of Pediatrics, Chongqing, China. emliu186@126.com. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. chenyaolong@lzu.edu.cn. Lanzhou University Institute of Health Data Science, Lanzhou, China. chenyaolong@lzu.edu.cn. School of Public Health, Lanzhou University, Lanzhou, China. chenyaolong@lzu.edu.cn. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China. chenyaolong@lzu.edu.cn. Lanzhou University GRADE Center, Lanzhou, China. chenyaolong@lzu.edu.cn.

European journal of pediatrics. 2022;:1-12
Abstract
The purpose of this systematic review is to evaluate the efficacy and safety of using potential drugs: remdesivir and glucocorticoid in treating children and adolescents with COVID-19 and intravenous immunoglobulin (IVIG) in treating MIS-C. We searched seven databases, three preprint platform, ClinicalTrials.gov, and Google from December 1, 2019, to August 5, 2021, to collect evidence of remdesivir, glucocorticoid, and IVIG which were used in children and adolescents with COVID-19 or MIS-C. A total of nine cohort studies and one case series study were included in this systematic review. In terms of remdesivir, the meta-analysis of single-arm cohort studies have shown that after the treatment, 54.7% (95%CI, 10.3 to 99.1%) experienced adverse events, 5.6% (95%CI, 1.2 to 10.1%) died, and 27.0% (95%CI, 0 to 73.0%) needed extracorporeal membrane oxygenation or invasive mechanical ventilation. As for glucocorticoids, the results of the meta-analysis showed that the fixed-effect summary odds ratio for the association with mortality was 2.79 (95%CI, 0.13 to 60.87), and the mechanical ventilation rate was 3.12 (95%CI, 0.80 to 12.08) for glucocorticoids compared with the control group. In terms of IVIG, most of the included cohort studies showed that for MIS-C patients with more severe clinical symptoms, IVIG combined with methylprednisolone could achieve better clinical efficacy than IVIG alone.Conclusions: Overall, the current evidence in the included studies is insignificant and of low quality. It is recommended to conduct high-quality randomized controlled trials of remdesivir, glucocorticoids, and IVIG in children and adolescents with COVID-19 or MIS-C to provide substantial evidence for the development of guidelines. What is Known: • The efficacy and safety of using potential drugs such as remdesivir, glucocorticoid, and intravenous immunoglobulin (IVIG) in treating children and adolescents with COVID-19/MIS-C are unclear. What is New: • Overall, the current evidence cannot adequately demonstrate the effectiveness and safety of using remdesivir, glucocorticoids, and IVIG in treating children and adolescents with COVID-19 or MIS-C. • We are calling for the publication of high-quality clinical trials and provide substantial evidence for the development of guidelines.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine