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MIS-C Treatment: Is glucocorticoid monotherapy enough for mild cases?

Murat Sütçü1, Emine Manolya Kara2, Funda Yıldız3

  • 1Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Infectious Diseases, Istanbul, Turkey.

The American Journal of Emergency Medicine
|July 13, 2024
PubMed
Summary

Glucocorticoid monotherapy is a safe and effective treatment for mild multisystem inflammatory syndrome (MIS-C) without cardiac involvement. This approach avoids the need for Intravenous immune globulin (IVIG) in less severe cases.

Keywords:
Cardiac involvementGlucocorticoid monotherapyMultisystem inflammatory syndrome in children (MIS-C)

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Area of Science:

  • Pediatrics
  • Immunology
  • Infectious Diseases

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition.
  • Current treatment guidelines often recommend Intravenous immune globulin (IVIG) in combination with glucocorticoids (GCs).
  • The necessity of IVIG in all MIS-C cases, particularly milder ones, requires further investigation.

Purpose of the Study:

  • To compare the effectiveness of glucocorticoid (GC) monotherapy versus combined GC and Intravenous immune globulin (IVIG) treatment in mild multisystem inflammatory syndrome (MIS-C) cases.
  • To evaluate clinical outcomes, including disease progression, shock, pediatric intensive care unit (PICU) admission, and need for additional immunosuppression.
  • To assess cardiovascular and infection-related complications at one-year follow-up.

Main Methods:

  • Retrospective cohort study of 97 MIS-C patients treated between June 2020 and June 2022.
  • Patients were divided into two groups: GC monotherapy (n=65) and GC + IVIG combination therapy (n=32).
  • Primary outcomes included clinical deterioration, shock, PICU admission, and need for further immunosuppression; secondary outcomes were cardiovascular and infection complications.

Main Results:

  • No mortality was observed in either group.
  • All patients, regardless of treatment, showed normal echocardiography findings and reported no complaints at one-year follow-up.
  • While 13.5% of patients required intensive care and 33% had cardiac findings, GC monotherapy was sufficient for mild cases without cardiac involvement.

Conclusions:

  • Glucocorticoid monotherapy appears to be a safe and viable alternative for treating mild multisystem inflammatory syndrome in children (MIS-C) when cardiac involvement is absent.
  • This finding suggests a potential de-escalation of treatment for select MIS-C patients, avoiding unnecessary IVIG administration.
  • Further prospective studies are warranted to confirm these preliminary findings and refine treatment protocols for MIS-C.