IVIG Compared With IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children

Area of Science:

• Pediatric critical care medicine
• Immunology
• Infectious diseases

Background:

• Multisystem inflammatory syndrome in children (MIS-C) is a serious condition requiring prompt and effective treatment.
• Intravenous immunoglobulin (IVIG) is a standard initial therapy for MIS-C.
• The addition of other immunomodulatory agents may improve outcomes.

Purpose of the Study:

• To compare the efficacy of initial treatment for MIS-C using IVIG alone versus IVIG combined with infliximab.
• To evaluate key clinical outcomes, including the need for further interventions and disease severity markers.

Main Methods:

• A retrospective cohort study was conducted on 72 children diagnosed with MIS-C.
• Patients were categorized based on initial treatment: IVIG alone or IVIG plus infliximab.
• The primary outcome assessed was the requirement for additional therapy 24 hours or more post-treatment initiation.

Main Results:

• The combination of IVIG and infliximab resulted in a significantly lower need for additional therapy (31% vs. 65%) compared to IVIG alone.
• Patients receiving IVIG plus infliximab experienced shorter intensive care unit (ICU) lengths of stay (median 1.8 vs. 3.3 days).
• This group also showed a trend towards reduced left ventricular dysfunction (4% vs. 20%) and a more rapid decrease in C-reactive protein levels.

Conclusions:

• Initial treatment of MIS-C with IVIG plus infliximab is associated with improved clinical outcomes compared to IVIG monotherapy.
• This combination therapy may reduce the need for subsequent treatments and shorten ICU stays.
• Further prospective studies are warranted to confirm these findings.