Comparative Analysis of Immunomodulatory Therapies for Multisystem Inflammatory Syndrome in Children

Several studies examining the initial treatment options for multisystem inflammatory syndrome in children (MIS-C) have generated contradictory findings. The present study compared the outcomes of MIS-C patients who received intravenous immunoglobulin (IVIG), glucocorticoids, or a combination of both. The study encompassed randomized or observational comparative studies that involved MIS-C patients under 21 years of age and looked for cardiovascular dysfunction (CD), which was defined as a left ventricular ejection fraction below 55% or the need for vasopressors beyond the second day of initial therapy. 

The study observed-

• Identification of 2635 studies and inclusion of 3 nonrandomized cohorts.
• Inclusion of 958 children in meta-analysis. 
• IVIG plus glucocorticoids group showed improved CD as compared with IVIG alone. 
• Glucocorticoids alone group did not show improved CD as compared with IVIG alone. 
• Glucocorticoids alone group did not show improved CD as compared with IVIG plus glucocorticoids. 
• Improved outcomes with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2).

Based on a comprehensive meta-analysis of patients with multisystem inflammatory syndrome in children (MIS-C), the combination of intravenous immunoglobulin (IVIG) and glucocorticoids demonstrated a significant improvement in cardiovascular dysfunction (CD) when compared to IVIG alone. However, the administration of glucocorticoids alone did not show any significant improvement in CD compared to either IVIG alone or the combination of IVIG and glucocorticoids.

Ouldali N, et al. Immunomodulatory Therapy for MIS-C. Pediatrics July 2023; 152 (1): e2022061173. 10.1542/peds.2022-061173