Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study
Authors' conclusion
Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids.
Study context
- Population
- Children (aged 0 months to 19 years) with clinically diagnosed multisystem inflammatory syndrome in children (MIS-C) from 39 countries, June 14, 2020, to April 25, 20222,009 analysed
- Participants
- 2,101 children
- Exposure
- IVIG plus GC, or GC alone, vs IVIG alone as primary treatment for MIS-C
- Intravenous immunoglobulinn = 680reference
- Intravenous immunoglobulin plus glucocorticoidsn = 698
- Glucocorticoids alonen = 487
- Outcome
- Co-primary: composite of inotropic or ventilator support from the second day after treatment initiation, or death; and time to improvement on an ordinal clinical severity scale
Methodological detailsinternational observational cohort, propensity-weighted (inverse probability weighting), IVIG as reference treatment
- International observational cohort
- Propensity-weighted (inverse probability weighting)
- IVIG as reference treatment
Main finding
As reported in the abstract
Ventilation, inotropic support, or death
Adjusted odds ratio (95% CI)P value
IVIG plus GCvs IVIG
1.09(0.75–1.58)
corrected p value=1.00GC alonevs IVIG
0.93(0.58–1.47)
corrected p value=1.00Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | P value | |
|---|---|---|---|
| Co-primary: time to improvementIVIG plus GCvs IVIG | adjusted average HR 1.04 (95% CI 0.91–1.20) | corrected p value=1.00 | |
| Co-primary: time to improvementGC alonevs IVIG | adjusted average HR 0.84 (95% CI 0.70–1.00) | corrected p value=0.22 | |
| Treatment escalationIVIG plus GCvs IVIG | OR 0.15 (95% CI 0.11–0.20) | P < 0.0001 | |
| Treatment escalationGC alonevs IVIG | OR 0.68 (95% CI 0.50–0.93) | P = 0.014 | |
| Persistent fever (from day 2 onward)IVIG plus GCvs IVIG | OR 0.50 (95% CI 0.38–0.67) | P < 0.0001 | |
| Persistent fever (from day 2 onward)IVIG plus GCvs GC alone | OR 0.63 (95% CI 0.45–0.88) | P = 0.0058 | |
| 0.10.31310Ratio (log scale) |
Coronary artery aneurysm occurrence and resolution
- Did not differ significantly between treatment groups
Original publication
Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study. Lancet Rheumatol. Published 14 February 2023. doi:10.
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