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Immunomodulation With IVIG, Glucocorticoids Examined in MIS-C

Early outcomes of two large observational studies show mixed results for the efficacy of immunomodulation with IVIG, glucocorticoids, or both

sick child in hospital

FRIDAY, June 25, 2021 (HealthDay News) -- The effectiveness of immunomodulation with intravenous immune globulin (IVIG), glucocorticoids, or both varies in multisystem inflammatory syndrome in children (MIS-C), according to results from two observational studies published online June 16 in the New England Journal of Medicine.

Mary Beth F. Son, M.D., from Boston Children's Hospital, and colleagues analyzed surveillance data on inpatients younger than 21 years with MIS-C who were admitted between March 15 and Oct. 31, 2020. The effectiveness of initial immunomodulatory therapy with IVIG plus glucocorticoids was compared to IVIG alone. The researchers found that in the propensity score-matched analysis, the risk for cardiovascular dysfunction on or after day 2 was lower with initial treatment with IVIG plus glucocorticoids (103 patients) versus IVIG alone (103 patients; 17 versus 31 percent; risk ratio, 0.56).

Andrew J. McArdle, M.B., B.Chir., from Imperial College London, and colleagues conducted an international observational cohort study to compare IVIG to IVIG plus glucocorticoids and glucocorticoids alone for MIS-C. Data were included for 614 children with suspected MIS-C: 246, 208, and 99 received IVIG alone, IVIG plus glucocorticoids, and glucocorticoids alone, respectively; the remaining children received other treatment combinations or no immunomodulatory therapy. The researchers observed no significant differences in the adjusted odds ratios for receipt of inotropic or ventilator support or death for patients who received IVIG plus glucocorticoids or glucocorticoids alone versus IVIG alone.

"Continued collaboration across centers is essential to decreasing the short-term incidence of death and complications, particularly as COVID-19 continues to circulate internationally, and to evaluating the effect of vaccination in younger age groups," writes the author of an accompanying editorial.

Several authors from the Son study and one author from the McArdle study disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text - Son

Abstract/Full Text - McArdle

Editorial

Physician's Briefing
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