Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children

Abstract

Key PointsQuestionIs there an association between treatment with intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone and course of fever in multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2?FindingsThis retrospective cohort study included 111 children with MIS-C. After propensity score matching, the rate of treatment failure (defined by the persistence of fever 2 days after the introduction of first-line therapy or recrudescence of fever within 7 days) for those who received IVIG plus methylprednisolone vs IVIGs alone was 9% vs 51%, a difference that was statistically significant.MeaningCombined treatment with methylprednisolone vs IVIG alone was associated with a better course of fever in MIS-C.

Acute covid-19 and multisystem inflammatory syndrome in children

“…Although it is rare, MIS-C is a critical diagnosis to consider in any child with fever, evidence of inflammation, and organ dysfunction where covid-19 is endemic. 29 Prompt treatment with intravenous immunoglobulin and steroids can reduce the inflammatory response and may improve outcomes.…”

“…A May 2020 systematic review from 26 countries reported a MIS-C incidence of 0.14% among all children with SARS-CoV-2 infection,1 but this estimated incidence may be imprecise because of potential underestimation of overall SARS-CoV-2 infections in children. Although it is rare, MIS-C is a critical diagnosis to consider in any child with fever, evidence of inflammation, and organ dysfunction where covid-19 is endemic 29. Prompt treatment with intravenous immunoglobulin and steroids can reduce the inflammatory response and may improve outcomes.…”

“…Data on outcomes and treatment efficacy is limited overall. However, a recent retrospective cohort study in France found that children with MIS-C who were treated with both intravenous immunoglobulin (IVIg) and methylprednisolone (n=72) had a lower risk of treatment failure compared with those treated with IVIg alone (n=34) 29. Further study is still needed to understand the pathophysiology of MIS-C to inform the most effective therapeutic interventions.…”

SARS-CoV-2 and Multisystem Inflammatory Syndrome In Children (MIS-C)

“…Both glucocorticoids and intravenous immunoglobulin (IVIG) are considered the most common first line treatment modalities for immunomodulatory treatment in MIS-C 5 . Although there is minimal research on the efficacy of IVIG and glucocorticoids in combination when compared with IVIG or glucocorticoids alone, a recent retrospective cohort study found that the combination of IVIG with glucocorticoids demonstrated a more favorable fever course than IVIG alone 7 . Respondents in a recent international survey reported steroid use most often in patients with severe clinical presentation (64%) 6 .…”

Passive Immunity Should and Will Work for COVID-19 for Some Patients

“…The benefits of IVIG are debatable, but several studies have not determined the pre-existing antiviral potency of the same [191][192][193][194][195]. Such studies do not preclude the potential benefit of IVIG in other niche situations, such as immune thrombocytopenia, ascending polyneuropathy, or multisystem inflammatory disorder attributable to COVID-19 [196][197][198]. On this theme, however, there is yet potential for the creation of IVIG specifically from donors with convalescent COVID-19 infection.…”