Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes

SPS commentary:

According to an editorial, since the sudden emergence of multisystem inflammatory disease in children (MIS-C) in April 2020 as a novel and severe presentation of Covid-19, nearly 4000 cases of MIS-C and 35 deaths have been reported in the US and many more internationally.

This is one of two studies in the Journal reporting early outcomes of large observational trials — results that superficially seem to have conflicting findings regarding the efficacy of immunomodulation with IVIG, glucocorticoids, or both.

The other study was an international observational cohort study of clinical and outcome data uploaded onto web-based database (n=614 children, 32 countries), which found no evidence that recovery differed after primary treatment with IVIG alone, IVIG plus glucocorticoids (GCs), or GCs alone.

 

The editorial discusses possible reasons for these apparently disparate results. It notes that it must be appreciated that neither of these groups of investigators has yet assessed the effect of therapies on long-term outcomes — specifically, the comparative efficacy for progression or resolution of coronary abnormalities, prolonged or permanent cardiac dysfunction, or scarring. It adds that systematic and comprehensive long-term follow-up for these and other noncardiac outcomes — including sequelae involving pulmonary issues, mental health, neurodevelopment, and quality of life — are sorely needed in the paediatric population and will launch soon. Meanwhile, continued collaboration across centers is essential to decreasing the short-term incidence of death and complications, particularly as Covid-19 continues to circulate internationally, and to evaluating the effect of vaccination in younger age groups.