Examining the use of immunomodulatory medication to treat MIS-C

In late April 2020, a mysterious condition, likely a post-COVID-19 complication, was reported in children in the United Kingdom, the United States, and other countries and was subsequently named multisystem inflammatory syndrome in children (MIS-C). A study in the New England Journal of Medicine reports on the efficacy of using immunomodulatory medications for treatment.¹

The investigators examined the surveillance data on patients aged younger than 21 years who had MIS-C and were admitted to 1 of 58 hospitals in the United States between March 15 and October 31, 2020. Intravenous immune globulin (IVIG) given on day 0 was compared to IVIG plus glucocorticoids. The primary outcome examined was cardiovascular dysfunction, which was a composite of left ventricular dysfunction or shock resulting in the use of vasopressors, either on or after day 2 treatment. Secondary outcomes included being administered adjunctive treatment on or after day 1 as well as a persistent or recurrent fever on or after day 2.

There were 518 patients with MIS-C who were given at least 1 immunomodulatory therapy. Seventy-five percent of the patients had been previously health and 9 subsequently died. Initial treatment with IVIG with glucocorticoids was linked to a lower risk of cardiovascular dysfunction than treatment with IVIG alone (17% vs. 31%; risk ratio, 0.56; 95% CI, 0.34 to 0.94). The chance of the components of the primary outcomes was lower in patients who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). Adjunctive therapy was used less in patients who had IVIG plus glucocorticoids than in patients who only received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65). Fever risk was roughly the same for both groups (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13).

The investigators concluded that the use of IVIG along with glucocorticoids initially to treat MIS-C was tied to a lower risk of both new or persistent cardiovascular dysfunction.

Reference

1. Son M, Murray N, Friedman K, et al. Multisystem inflammatory syndrome in children — initial therapy and outcomes. New England Journal of Medicine. 2021;385(1):23-34. doi:10.1056/nejmoa2102605