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Immunomodulatory Therapy for MIS-C

Division of Infectious diseases, Department of Pediatric Infectious Diseases, Sainte Justine University Hospital, University of Montreal, Quebec, Canada. Infection, Antimicrobials, Modelling, Evolution, Inserm, UMR 1137, Paris University, Paris, France. Association Clinique et, Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Division of Immunology, Boston Children's Hospital, Boston, Massachusetts. Section of Pediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, United Kingdom. Hospices Civils de Lyon, Pediatric Nephrology, Rheumatology, Dermatology, Hopital Femme, Mère Enfant, Centre International de Recherche en Infectiologie/INSERM U1111, Bron, France. Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université De Paris, Paris, France. COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia. Department of Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.

Pediatrics. 2023;152(1)
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Abstract
CONTEXT Studies comparing initial therapy for multisystem inflammatory syndrome in children (MIS-C) provided conflicting results. OBJECTIVE To compare outcomes in MIS-C patients treated with intravenous immunoglobulin (IVIG), glucocorticoids, or the combination thereof. DATA SOURCES Medline, Embase, CENTRAL and WOS, from January 2020 to February 2022. STUDY SELECTION Randomized or observational comparative studies including MIS-C patients <21 years. DATA EXTRACTION Two reviewers independently selected studies and obtained individual participant data. The main outcome was cardiovascular dysfunction (CD), defined as left ventricular ejection fraction < 55% or vasopressor requirement ≥ day 2 of initial therapy, analyzed with a propensity score-matched analysis. RESULTS Of 2635 studies identified, 3 nonrandomized cohorts were included. The meta-analysis included 958 children. IVIG plus glucocorticoids group as compared with IVIG alone had improved CD (odds ratio [OR] 0.62 [0.42-0.91]). Glucocorticoids alone group as compared with IVIG alone did not have improved CD (OR 0.57 [0.31-1.05]). Glucocorticoids alone group as compared with IVIG plus glucocorticoids did not have improved CD (OR 0.67 [0.24-1.86]). Secondary analyses found better outcomes associated with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2). LIMITATIONS Nonrandomized nature of included studies. CONCLUSIONS In a meta-analysis of MIS-C patients, IVIG plus glucocorticoids was associated with improved CD compared with IVIG alone. Glucocorticoids alone was not associated with improved CD compared with IVIG alone or IVIG plus glucocorticoids.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine