Treatment of Multisystem Inflammatory Syndrome in Children

• Published in: Pediatrics (Evanston) 2022-12, Vol.150 (Supplement 3), p.S67-S67
• Main Authors: Knox, Samantha K., Mahr, Todd A.
• Format: Article
• Language: English
• Subjects: Calcium-binding protein; Coronary artery; Coronaviruses; Echocardiography; Glucocorticoids; Heart; Immunoglobulins; Immunomodulation; Inflammatory diseases; Intravenous administration; Mechanical ventilation; Multisystem inflammatory syndrome in children; Patients; Pediatrics; Population studies; Severe acute respiratory syndrome coronavirus 2; Troponin; Ventilation; Ventricle
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2022-059346WWWW

PURPOSE OF STUDY: To summarize the evidence on treatments for multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children. STUDY POPULATION: Pediatric patients with suspected MIS-C or other inflammatory illness after SARS-CoV-2 infection between June 20th, 2020 and February 24th, 2021. METHODS: Pediatricians worldwide were invited to upload their data into a central database for any pediatric patient with suspected MIS-C or any inflammatory disease after SARS-CoV-2 infection. Deidentified data, including demographics, clinical features, laboratory results, treatments (including intravenous immunoglobulin [IVIG], glucocorticoid, and biologic medications), and hospital stay length were collected and analyzed. Three primary treatment groups were compared: IVIG alone, IVIG plus glucocorticoid, and glucocorticoid alone, with IVIG alone classified as primary treatment based upon prestudy acceptance of IVIG as a primary treatment. Day 0 was considered the first calendar day of treatment of each treatment modality. There were 2 primary outcomes: (1) inotropic or mechanical ventilation (invasive or noninvasive) by day 2 or later or death; (2) reduction in disease severity on a seven-point scale between day 0 and 2. A subgroup analysis of only those meeting World Health Organization (WHO) criteria for MIS-C were included. Secondary outcomes included trends in inflammatory markers, escalation of immunomodulators, time to decrease in disease severity by 1 point, left ventricular dysfunction on echocardiogram, coronary artery aneurysm after treatment and increase in cardiorespiratory support after day 0. RESULTS: A total of 614 patients, among 81 hospitals in 34 countries, had suspected MIS-C. Of these, 246 received primary treatment with IVIG, 208 with IVIG plus glucocorticoid, and 99 with glucocorticoid alone. An additional 22 patients received immunomodulators, and 39 patients received no immunomodulatory treatment. Troponin levels and percentage of patients on inotropic agents on day 0 were higher in the IVIG plus glucocorticoid group. The first primary outcome occurred in 56 patients with IVIG plus glucocorticoid (odds ratio [OR] 0.77 compared with IVIG alone; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients on glucocorticoids alone (OR 0.54; 95% CI, 0.22 to 1.33). In the subgroup analysis, 490 (80%) patients met WHO criteria for MIS-C and the first primary outcome occurred in 40