Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India

Abstract

Objective To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. Methods In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. ResultsThe data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). Conclusion While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.

Methylprednisolone versus intravenous immunoglobulins in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): an open-label, multicentre, randomised trial

“… 24 Six large observational studies have assessed effectiveness of glucocorticoid monotherapy, intravenous immunoglobulins, or intravenous immunoglobulins plus glucocorticoids. 12 , 13 , 14 , 15 , 23 , 25 Son and colleagues 13 compared 103 propensity-matched patients treated with intravenous immunoglobulins plus glucocorticoids with 103 patients treated with intravenous immunoglobulins alone. Initial treatment with glucocorticoids and intravenous immunoglobulins was associated with lower risk of the composite outcome of cardiovascular dysfunction on or after day 2 than intravenous immunoglobulins alone (17% vs 31%, risk ratio 0·56, 95% CI 0·34–0·94).…”

“…However, when comparing hospital length of stay between these groups in mixed linear regression analyses, no significant difference was observed after adjusting for confounding variables. Bagri and colleagues 25 showed in their propensity score matched analysis that patients treated with glucocorticoids (n=45) versus intravenous immunoglobulins combined with glucocorticoids (n=84) did not differ in relation to the need of inotropes or respiratory support 2 days and later after treatment initiation.…”

Post-COVID-19 Sequelae in Children

“…MIS-C is itself a serious complication of COVID-19 [19]. CVS is the most common sequelae of MIS-C. Like Kawasaki disease (KD), coronary artery aneurysms and dilation have been documented in 20%-25% of children [20].…”

A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

“…The optimal treatment regime is still under debate because of scarce and conflicting data. For instance, no differences in death or need for vasoactive support or mechanical ventilation was observed between IVIG alone, glucocorticoids alone, and IVIG with glucocorticoid treatment groups [98,99]. However, IVIG with glucocorticoid was shown to be superior to IVIG alone and glucocorticoid alone in reducing ICU duration, but not the overall length of hospital stay [100].…”