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The Effect of Biologics in the Treatment of Multisystem Inflammatory Syndrome in Children (Mis-C): A Single-Center
Ozge Basaran1, Ezgi Deniz Batu1, Ummusen Kaya Akca1
1Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) treatment with IVIG and corticosteroids showed no adverse cardiac outcomes. Adding biologics to MIS-C treatment may increase cardiac complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection.
- Optimal MIS-C treatment strategies remain under investigation.
Purpose of the Study:
- To compare clinical outcomes in MIS-C patients treated with IVIG plus corticosteroids versus IVIG plus corticosteroids and a biologic agent.
- To assess the impact of initial treatment on cardiac function and need for inotropic support.
Main Methods:
- Propensity score (PS)-matching was used to create comparable cohorts.
- Included 79 MIS-C patients, with 50 in the PS-matched cohort (25 per group).
- Primary outcome: left ventricular ejection fraction <55% and/or inotrope support on day 2+.
Main Results:
- None of the patients receiving IVIG and corticosteroids experienced the primary outcome.
- Eight patients (32%) in the IVIG plus corticosteroids and biologic group experienced the primary outcome (p=0.04).
Conclusions:
- Initial treatment with IVIG and corticosteroids alone was associated with favorable cardiac outcomes in MIS-C patients.
- Adding biologic agents to initial MIS-C therapy may be linked to adverse cardiac events.
- Further research, including randomized controlled trials, is needed for definitive treatment recommendations.
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition characterized by excessive inflammation that can arise as a complication of SARS-CoV-2 infection in children. While our understanding of COVID-19 and MIS-C has been advancing, there is still uncertainty regarding the optimal treatment for MIS-C. In this study, we aimed to compare the clinical and laboratory outcomes of MIS-C patients treated with IVIG plus corticosteroids (CS) to those treated with IVIG plus CS and an additional biologic drug. We used the propensity score (PS)-matching method to assess the relationships between initial treatment and outcomes. The primary outcome was a left ventricular ejection fraction of less than 55% on day 2 or beyond and/or the requirement of inotrope support on day 2 or beyond. We included 79 MIS-C patients (median age 8.51 years, 33 boys) followed in our center. Among them, 50 children (25 in each group) were allocated to the PS-matched cohort sample. The primary outcome was observed in none of the patients in the IVIG and CS group, while it occurred in eight patients in the IVIG plus CS and biologic group (p = 0.04). MIS-C is a disorder that may progress rapidly and calls for extensive care. For definitive recommendations, further studies, including randomized control trials, are required.
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