COVID-19: Methylprednisolone Added to IVIG Yields Better MIS-C Outcomes

Sarfaroj Khan 

Disclosures

February 08, 2021

Takeaway

Why this matters

  • MIS-C is a new pediatric entity that is potentially life-threatening, and clinicians are seeking optimal therapeutic strategies.

  • A Delphi consensus study settled on proposing IVIG as initial therapy.

Key results

  • 111 children met WHO MIS-C criteria.

    • Median age, 8.6 (interquartile range, 4.7-12.1) years.

    • 34 received first-line IVIG/methylprednisolone, and 72 received IVIG alone.

    • 5 received neither.

  • IVIG+methylprednisolone vs IVIG alone:

    • Treatment failure rates: 9% vs 38%.

      • Absolute risk difference: −0.28 (95% CI, −0.48 to −0.08).

      • OR: 0.25 (P=.008).

    • Acute left ventricular dysfunction: 17% vs 35%.

      • Absolute risk difference: −0.18 (95% CI, −0.35 to −0.01). 

      • OR: 0.20 (P=.007).

    • Hemodynamic support needed: 6% vs 23%. 

      • Absolute risk difference: −0.17 (95% CI, −0.34 to −0.004). 

      • OR: 0.21 (P=.01).

  • Second-line treatment needs were reduced and pediatric ICU stays shorter with the combination.

Study design

  • Retrospective, cohort analysis, France, comparing IVIG 2 g/kg plus methylprednisolone vs IVIG alone as initial MIS-C therapy, based on propensity score matching.

  • Funding: Pfizer; Square Foundation.

Limitations

  • Observational.

  • Confounding by indication.

  • Varied dosing, administration routes.

  • Mortality underascertained.

 

Ouldali N, Toubiana J, Antona D, Javouhey E, Madhi F, Lorrot M, Léger PL, Galeotti C, Claude C, Wiedemann A, Lachaume N, Ovaert C, Dumortier M, Kahn JE, Mandelcwajg A, Percheron L, Biot B, Bordet J, Girardin ML, Yang DD, Grimaud M, Oualha M, Allali S, Bajolle F, Beyler C, Meinzer U, Levy M, Paulet AM, Levy C, Cohen R, Belot A, Angoulvant F; French Covid-19 Paediatric Inflammation Consortium. Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA. 2021 Feb 1 [Epub ahead of print]. doi: 10.1001/jama.2021.0694. PMID: 33523115 View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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