Corticosteroids may be an effective and accessible treatment for COVID-19-linked multisystem inflammatory syndrome in children (MIS-C).
This is the finding of an international observational cohort study of 614 children with MIS-C from 32 countries published in the New England Journal of Medicine.
MIS-C affects an estimated one in 50,000 children with SARS-CoV-2 infection. While the majority recover well, international data suggest a fatality rate of 2% to 4%.
In this study led by Imperial College London, researchers evaluated clinical and outcome data from a web-based clinician database where suspected MIS-C was treated with intravenous immune globulin (IVIG), IVIG plus glucocorticoids and glucocorticoids alone.
Of the total cohort (n=614), 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids and 99 with glucocorticoids alone. Also, 22 received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy.
All three assessed treatments resulted in more rapid resolution of inflammation as measured by C-reactive protein (CRP); the CRP fell by half approximately one day quicker in those receiving treatment.
There were no clear differences between the three treatments in the rate of recovery from organ failure or progression to organ failure.
While the number of fatal cases (2%) was too low to enable comparison between treatments, when death was assessed together with organ failure, there were no significant differences between the three treatments.
However, when the analysis was restricted to the 80% (490) who met the World Health Organization’s criteria for MIS-C, there was evidence of a lower rate of organ support or death at two days in those receiving steroids alone as initial treatment compared with immunoglobulin alone.
Study co-author Dr Elizabeth Whittaker said: “The finding that outcome is similar for patients treated with steroids alone as with those treated with steroids and immunoglobulin or immunoglobulin alone, suggests that steroids may be a cheaper and more available alternative to immunoglobulin."
N Engl J Med. Published online June 16, 2021. Full text
References: McArdle AJ, Vito O, Patel H, Seaby EG, Shah P, Wilson C, Broderick C, Nijman R, Tremoulet AH, Munblit D, Ulloa-Gutierrez R, Carter MJ, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Levin M; BATS Consortium. Treatment of Multisystem Inflammatory Syndrome in Children. N Engl J Med. 2021 Jun 16 [Epub ahead of print]. doi: 10.1056/NEJMoa2102968. PMID: 34133854
This article originally appeared on Univadis, part of the Medscape Professional Network
