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

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.