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Treatment of MIS-C in Children and Adolescents
Sanaa Mahmoud1,2, Mostafa El-Kalliny3,4, Alyaa Kotby5
1Division of Allergy and Immunology, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
Insights
Multisystem inflammatory syndrome in children (MIS-C) treatment involves immunomodulatory drugs like IVIG and glucocorticoids. Refractory cases may require biologic agents or combination therapies for optimal outcomes.
Area of Science:
- Pediatric rheumatology
- Infectious diseases
- Immunology
Background:
- COVID-19-related multisystem inflammatory syndrome in children (MIS-C) presents a complex clinical challenge.
- The exact pathogenesis of MIS-C remains incompletely understood, necessitating a review of current management strategies.
Purpose of the Study:
- To comprehensively review and summarize published recommendations and management strategies for MIS-C.
- To consolidate current evidence on therapeutic approaches for MIS-C.
Main Methods:
- Systematic review of existing literature on MIS-C treatment.
- Analysis of published recommendations and management guidelines.
- Evaluation of evidence for different therapeutic regimens.
Main Results:
- First-tier therapy for MIS-C commonly includes intravenous immunoglobulin (IVIG) and glucocorticoids.
- Refractory MIS-C cases often require escalation to biologic agents (anakinra, tocilizumab, infliximab).
- Evidence regarding monotherapy versus combination therapy and thrombotic risk management is reviewed.
Conclusions:
- Current MIS-C management primarily relies on immunomodulatory agents.
- Further research is needed to establish optimal evidence-based management plans for short- and long-term outcomes.
- Addressing thrombotic risk is a critical component of MIS-C care.
Purpose Of Review:
Different treatment approaches have been described for the management of COVID-19-related multisystem inflammatory syndrome in children (MIS-C), the pathogenesis of which has not yet been fully elucidated. Here, we comprehensively review and summarize the recommendations and management strategies that have been published to date.
Recent Findings:
MIS-C patients are treated with different regimens, mostly revolving around the use of immunomodulatory medications, including IVIG and glucocorticoids as first-tier therapy. Refractoriness to IVIG and glucocorticoids warrants a step-up of immunomodulatory therapy to biologic agents such as anakinra, tocilizumab, and infliximab.
Summary:
We review the current evidence regarding the use of monotherapy versus combination therapy, as well as the current recommendations for assessing thrombotic risk and administering antiplatelet and anticoagulant therapy. We anticipate that future studies will provide evidence for management plans that maximize short- and long-term outcomes.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s40124-021-00259-4.
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