Treating MIS-C with intravenous immunoglobulins and methylprednisolone to improve fever course

As with coronavirus disease 2019 (COVID-19), there has been a push to find the best treatments for multisystem inflammatory syndrome in children (MIS-C) that’s been linked to COVID-19. An investigation in JAMA look at whether including methylprednisolone with intravenous immunoglobulins has an impact in comparison to intravenous immunoglobulins.¹

The investigators performed a retrospective cohort study that came from a national surveillance system with propensity score–matched analysis. All cases of suspected MIS-C were reported to the French National Public Health Agency. All confirmed MIS-C cases that fulfilled the World Health Organization definition were included in the study. The study began in April 2020 and the follow-up ended on January 6, 2021.

The cohort covered 181 suspected MIS-C and 111 fulfilled the World Health Organization definition. Five of the affected children did not undergo either form of treatment. Of the 34 children in the intravenous immunoglobulins and methylprednisolone group, 3 children did not respond to the treatment and 37 of the 72 children in the intravenous immunoglobulins group also did not respond to treatment. Overall treating with intravenous immunoglobulins and methylprednisolone versus only intravenous immunoglobulins was linked to a lower risk of treatment failure (absolute risk difference, −0.28 [95% CI, −0.48 to −0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = .008). Furthermore, using intravenous immunoglobulins with methylprednisolone versus intravenous immunoglobulins alone was significantly linked to a number of things including lower risk of use of second-line therapy (absolute risk difference, −0.22 [95% CI, −0.40 to −0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = .004), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, −0.18 [95% CI, −0.35 to −0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]), duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; difference in days, −2.4 [95% CI, −4.0 to −0.7]), and hemodynamic support (absolute risk difference, −0.17 [95% CI, −0.34 to −0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]).

The researchers concluded that using intravenous immunoglobulins with methylprednisolone rather than intravenous immunoglobulins alone when treating MIS-C was linked to a more favorable fever course for the patients.

Reference

1. Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children. JAMA. February 1, 2021. Epub ahead of print. doi:10.1001/jama.2021.0694