Infectious Disease

IV immunoglobulin plus methylprednisolone in reference to a greater course of fever with MIS-C

February 02, 2021

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Angoulvant does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Treatment with iv immunoglobulin plus methylprednisolone resulted in a more favorable fever and fewer complications in children with COVID-19-related multisystem inflammatory syndrome than with intravenous immunoglobulins alone.

“In April 2020, severe systemic hyperinflammatory diseases were reported in children in Europe and the United States, occurring 2 to 4 weeks after SARS-CoV-2 infection.” François Angoulvant, MD, PhD, of Necker-Enfants Malades Hospital and the University of Paris, said Healio Rheumatology. “This novel entity, called Multisystem Inflammatory Syndrome in Children (MIS-C), is associated with a variety of clinical features including persistent fever, digestive symptoms, rash, bilateral non-purulent conjunctivitis, mucocutaneous inflammation, and frequent cardiovascular involvement. ”

Source: Adobe Stock

“Our study provides evidence-based data showing the superiority of IVIG plus methylprednisolone over IVIG alone in treating MIS-C,” said Dr. François Angoulvant to Healio Rheumatology. “Our results should quickly lead to new guidelines to consider this therapeutic option as a first-line therapy for MIS-C.” Source: Adobe Stock

“Many children with MIS-C have received empirical treatment based on Kawasaki disease guidelines with intravenous immunoglobulin (IVIG) alone or in combination with corticosteroids,” he added. “In the absence of evidence, a UK Delphi consensus study suggested treating MIS-C with IVIG as initial therapy. However, this was based on expert advice and no comparative study supported its conclusions. Overall, amid a global surge in SARS-CoV-2 infection, MIS-C treatment, which is based on evidence-based medicine, is still lacking and urgently needed. “

In order to compare IVIG plus methylprednisolone as initial therapy for MIS-C with IVIG alone, Angoulvant and colleagues carried out a retrospective cohort study using data from the French public health department. In total, the researchers included 111 cases in their analysis that meet the WHO definition of MIS-C. Of the patients included, 34 received IVIG plus methylprednisolone and 72 received IVIG only. Five children received no therapy. The study began on April 1, 2020 with a follow-up period until January 6.

François Angoulvant

The primary outcome was the persistence of the fever 2 days after starting initial therapy or the recurrence of the fever within 7 days, the latter being defined as treatment failure. Secondary outcomes included use of second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in a pediatric intensive care unit. The researchers’ primary analysis included a slope value consistent with a minimum caliper of 0.1.

According to the researchers, 9% of children who received IVIG plus methylprednisolone did not respond to treatment, compared with 51% of the IVIG monotherapy group. Overall, initial therapy with IVIG plus methylprednisolone compared to IVIG alone was associated with a lower risk of treatment failure, with an absolute risk difference of -0.28 (95% CI, -0.48 to -0.08) and one Odds ratio of 0.25 (95% CI, 0.09-0.7).

Furthermore, compared to IVIG monotherapy, IVIG plus methylprednisolone with an absolute risk difference of –0.22 (95% CI, –0.4 to –0.04) and an odds ratio of 0.19 was significantly lower risk for associated with the use of second-line therapy (95% CI, 0.06-0.61).

The combination therapy group also showed significantly lower risks for hemodynamic support with an absolute risk difference of -0.17 (95% CI, -0.34 to -0.004) and an odds ratio of 0.21 (95% CI, 0.06– 0.76); acute left ventricular dysfunction after initial therapy with an absolute risk difference of -0.18 (95% CI, -0.35 to -0.01) and an odds ratio of 0.2 (95% CI, 0.06-0.66 ); and a longer duration in the intensive care unit for children with a mean stay of 4 versus 6 days (difference in days = –2.4; 95% CI, –4 to –0.7).

“Reducing the risk of these life-threatening acute complications is of critical concern,” Angoulvant said. “Our study provides evidence-based data showing the superiority of IVIG plus methylprednisolone over IVIG alone in the treatment of MIS-C. Our results should quickly lead to new guidelines for considering this therapeutic option as a first-line therapy for MIS-C. “

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