Immunomodulatory Therapy for MIS-C
CONTEXT: Studies comparing initial therapy for multisystem inflammatory syndrome in children (MIS-C) provided conflicting results.
OBJECTIVE: To compare outcomes in MIS-C patients treated with intravenous immunoglobulin (IVIG), glucocorticoids, or the combination thereof.
DATA SOURCES: Medline, Embase, CENTRAL and WOS, from January 2020 to February 2022.
STUDY SELECTION: Randomized or observational comparative studies including MIS-C patients <21 years.
DATA EXTRACTION: Two reviewers independently selected studies and obtained individual participant data. The main outcome was cardiovascular dysfunction (CD), defined as left ventricular ejection fraction < 55% or vasopressor requirement ≥ day 2 of initial therapy, analyzed with a propensity score-matched analysis.
RESULTS: Of 2635 studies identified, 3 nonrandomized cohorts were included. The meta-analysis included 958 children. IVIG plus glucocorticoids group as compared with IVIG alone had improved CD (odds ratio [OR] 0.62 [0.42-0.91]). Glucocorticoids alone group as compared with IVIG alone did not have improved CD (OR 0.57 [0.31-1.05]). Glucocorticoids alone group as compared with IVIG plus glucocorticoids did not have improved CD (OR 0.67 [0.24-1.86]). Secondary analyses found better outcomes associated with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2).
LIMITATIONS: Nonrandomized nature of included studies.
CONCLUSIONS: In a meta-analysis of MIS-C patients, IVIG plus glucocorticoids was associated with improved CD compared with IVIG alone. Glucocorticoids alone was not associated with improved CD compared with IVIG alone or IVIG plus glucocorticoids.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:152 |
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| Enthalten in: |
Pediatrics - 152(2023), 1 vom: 01. Juli |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ouldali, Naïm [VerfasserIn] |
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| Links: |
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| Themen: |
Glucocorticoids |
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| Anmerkungen: |
Date Completed 03.07.2023 Date Revised 16.11.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1542/peds.2022-061173 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358782732 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a CONTEXT: Studies comparing initial therapy for multisystem inflammatory syndrome in children (MIS-C) provided conflicting results | ||
| 520 | |a OBJECTIVE: To compare outcomes in MIS-C patients treated with intravenous immunoglobulin (IVIG), glucocorticoids, or the combination thereof | ||
| 520 | |a DATA SOURCES: Medline, Embase, CENTRAL and WOS, from January 2020 to February 2022 | ||
| 520 | |a STUDY SELECTION: Randomized or observational comparative studies including MIS-C patients <21 years | ||
| 520 | |a DATA EXTRACTION: Two reviewers independently selected studies and obtained individual participant data. The main outcome was cardiovascular dysfunction (CD), defined as left ventricular ejection fraction < 55% or vasopressor requirement ≥ day 2 of initial therapy, analyzed with a propensity score-matched analysis | ||
| 520 | |a RESULTS: Of 2635 studies identified, 3 nonrandomized cohorts were included. The meta-analysis included 958 children. IVIG plus glucocorticoids group as compared with IVIG alone had improved CD (odds ratio [OR] 0.62 [0.42-0.91]). Glucocorticoids alone group as compared with IVIG alone did not have improved CD (OR 0.57 [0.31-1.05]). Glucocorticoids alone group as compared with IVIG plus glucocorticoids did not have improved CD (OR 0.67 [0.24-1.86]). Secondary analyses found better outcomes associated with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2) | ||
| 520 | |a LIMITATIONS: Nonrandomized nature of included studies | ||
| 520 | |a CONCLUSIONS: In a meta-analysis of MIS-C patients, IVIG plus glucocorticoids was associated with improved CD compared with IVIG alone. Glucocorticoids alone was not associated with improved CD compared with IVIG alone or IVIG plus glucocorticoids | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 650 | 7 | |a Immunoglobulins, Intravenous |2 NLM | |
| 700 | 1 | |a Son, Mary Beth F |e verfasserin |4 aut | |
| 700 | 1 | |a McArdle, Andrew J |e verfasserin |4 aut | |
| 700 | 1 | |a Vito, Ortensia |e verfasserin |4 aut | |
| 700 | 1 | |a Vaugon, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Belot, Alexandre |e verfasserin |4 aut | |
| 700 | 1 | |a Leblanc, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Murray, Nancy L |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Manish M |e verfasserin |4 aut | |
| 700 | 1 | |a Levin, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Randolph, Adrienne G |e verfasserin |4 aut | |
| 700 | 1 | |a Angoulvant, François |e verfasserin |4 aut | |
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