Initial Treatment of MIS-C With IVIG and Glucocorticoids Reduces Risk of Cardiovascular Dysfunction

July 14, 2021

Treating multisystem inflammatory syndrome in children (MIS-C) initially with intravenous immune globulin (IVIG) and glucocorticoids reduced the risk of serious short-term adverse outcomes, including cardiovascular dysfunction, than those who receive an initial treatment of IVIG alone, according to a study published in The New England Journal of Medicine.

“It is important to realise that MIS-C is still a new disease process in its infancy, and this is the first large-scale article published looking at treatment options and patient outcomes,” said Steven M. Horwitz, MD, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. “At our own institution, we have seen an evolution of the initial work-up and treatment of MIS-C over the past year, and a relatively large study such as this will help guide future treatment options.”

Study findings showed that, while nearly a third (31%) of children and adolescents treated with IVIG alone experienced new or persistent cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on the second day of treatment or later, that number dropped to 17% for patients whose initial therapy combined IVIG and glucocorticoids. In addition, IVIG and glucocorticoids as initial treatment required less adjunctive therapy on or after the first day of treatment than those who were initially treated with IVIG alone (34% vs 70%).

The study included outcomes of more than 596 children and adolescents who had been admitted with MIS-C to 1 of 58 US hospitals between March 15, 2020, and October 31, 2020, in the hopes of providing data that could guide MIS-C treatment in the future.

“While vaccines have played a massive role in reducing the spread of COVID, we are all aware that COVID and MIS-C are not going away anytime soon,” said Dr. Horwitz. “We are now seeing new variants with higher transmission rates and less protection from the vaccines. As such, we expect to keep seeing MIS-C. Although MIS-C by definition affects multiple organ systems, the cardiac dysfunction -- including arrhythmias, dilated coronary arteries and decreased function -- continues to be the biggest concern. With effective treatment, these patients tend to improve in a timely manner and quicker than what we have historically seen with other forms of viral myocarditis.”

Reference: https://www.nejm.org/doi/10.1056/NEJMoa2102605

SOURCE: Rutgers Robert Wood Johnson Medical School