Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies

Scarceevidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and...

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Detalhes bibliográficos
Autores: Tagarro A, Domínguez-Rodríguez S, Mesa JM, Epalza C, Grasa C, Iglesias-Bouzas MI, Fernández-Cooke E, Calvo C, Villaverde S, Torres-Fernández D, Méndez-Echevarria A, Leoz I, Fernández-Pascual M, Saavedra-Lozano J, Soto B, Aguilera-Alonso D, Rivière JG, Fumadó V, Martínez-Campos L, Vivanco A, Pilar-Orive FJ, Alcalá P, Ruiz B, López-Machín A, Oltra M, Moraleda C
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2023
País:España
Recursos:Fundació Sant Joan de Déu
Repositório:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p22483
Acesso em linha:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=22483
Access Level:Acceso aberto
Palavra-chave:SARS-CoV-2
COVID-19
MIS-C
Children
Descrição
Resumo:Scarceevidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p= 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p =0 .011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG. Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment.

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