Intravenous methylprednisolone reduces hospital stay for children with Multisystem Inflammatory Syndrome
In the ongoing battle against the multifaceted impacts of COVID-19, the RECOVERY trial examined treatment approaches for Pediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), shedding light on effective interventions and their outcomes in children. This study was published in the journal The Lancet: Child and Adolescent Health by Faust SN and colleagues.
PIMS-TS, also known as Multisystem Inflammatory Syndrome in Children (MIS-C), emerged as a concerning condition associated with COVID-19 in pediatric patients. This study focused on evaluating the effects of intravenous immunoglobulin, corticosteroids, tocilizumab, and anakinra compared with usual care on the duration of hospital stay for children with PIMS-TS.
Conducted across 51 UK hospitals, this randomized, controlled, open-label trial enrolled 237 children under 18 with PIMS-TS. The trial included two randomizations, the first assessing the impact of intravenous immunoglobulin or methylprednisolone compared with usual care, and the second evaluating tocilizumab or anakinra for inflammation refractory to initial treatment. The primary outcome measured was the duration of hospital stay.
Key Findings:
Intravenous methylprednisolone significantly reduced the duration of hospital stay compared with usual care (mean difference -0.7 days).
Tocilizumab, as a second-line treatment, demonstrated a substantial reduction in hospital stay duration compared with usual care (mean difference -3.3 days).
Intravenous immunoglobulin and anakinra showed no significant impact on the duration of hospital stay compared with usual care.
Few adverse events were reported, with two persistent coronary artery aneurysms in the usual care group.
The RECOVERY trial provides evidence supporting the efficacy of intravenous methylprednisolone as a first-line treatment and tocilizumab as a second-line treatment for pediatric patients with PIMS-TS. However, intravenous immunoglobulin and anakinra did not exhibit notable benefits compared with usual care.
Reference:
Faust, S. N., Haynes, R., Jones, C. E., Staplin, N., Whittaker, E., Jaki, T., Juszczak, E., Spata, E., Wan, M., Bamford, A., Dimitri, P., Finn, A., Furness, J., Ramanan, A. V., Gale, C., Cathie, K., Drysdale, S., Bernatoniene, J., Murray, C., … Zuriaga-Alvaro, A. Immunomodulatory therapy in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): a randomised, controlled, open-label, platform trial. The Lancet. Child & Adolescent Health,2024. https://doi.org/10.1016/s2352-4642(23)00316-4
