IVIG Plus Methylprednisolone better than IVIG Alone in MIS-C: JAMA study

Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with severe acute respiratory syndrome coronavirus 2 infection, potentially life-threatening, but the optimal therapeutic strategy remains unknown.

Hence, Naïm Ouldali and associates from the Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Paris, France conducted the study to compare intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone as initial therapy in MIS-C.

The authors carried out a retrospective cohort study among 181 children with suspected MIS-C, out of which 111 fulfilled the World Health Organization definition. The sample included 58 females [52%] with a median age of 8.6 years drawn from a national surveillance system with propensity score-matched analysis. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the World Health Organization definition were included in the study.

The primary outcome was defined as the persistence of fever 2 days after the introduction of initial therapy or recrudescence of fever within 7 days, which defined treatment failure whereas, the secondary outcomes included a second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit.

The following key findings were highlighted-

1. Treatment with IVIG and methylprednisolone vs IVIG alone was associated with 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).
2. IVIG and methylprednisolone therapy vs IVIG alone was also significantly associated with a 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), hemodynamic support (absolute risk difference, −0.17 [95% CI, −0.34 to −0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]), 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]), and duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; the difference in days, −2.4 [95% CI, −4.0 to −0.7]).

Therefore, it was concluded that "among children with MIS-C, treatment with IVIG and methylprednisolone vs IVIG alone were associated with a more favorable fever course."