Dual therapy improves cardiac outcomes in pediatric patients suffering from MIS-C

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Children's Health

A recent study by a multidisciplinary team of cardiologists and infectious disease specialists at Children’s Hospital Colorado (Children’s Colorado) found that pediatric patients suffering from Multisystem Inflammatory Syndrome (MIS-C) who received initial, intensified therapy consisting of intravenous immunoglobulin (IVIG) plus Infliximab had improved cardiac outcomes versus those who received IVIG alone. In addition, those patients had a decreased need for additional therapies, decreased length-of-stay in the ICU, decreased development of left ventricular dysfunction and more rapid resolution of inflammation. Infliximab is a medication often used to treat autoimmune diseases.

As a result of the improved outcomes associated with IVIG plus Infliximab, Children’s Colorado has updated its MIS-C care pathway to recommend administration of intensified initial therapy (IVIG plus Infliximab) for all patients highly suspected or diagnosed with MIS-C. MIS-C is a condition where different parts of the body can become inflamed, including the heart, lungs, kidneys and brain, and is associated with the virus that causes COVID-19.

While further randomized controlled trials are necessary to confirm these findings, the demonstrated improvement in cardiac and other outcomes associated with IVIG plus Infliximab made it imperative that we share this updated clinical pathway as quickly as possible.”

Sam Dominguez, MD, PhD, infectious disease specialist at Children’s Colorado and co-author of the study

The research, which was released prepublication in Pediatrics on Sept. 20 to expedite access to the findings, is based on a retrospective cohort study of 72 pediatric MIS-C patients comparing outcomes of those who received an initial treatment of IVIG alone to those who received initial treatment with IVIG plus Infliximab.

“Children’s Colorado has extensive experience in treating high-risk Kawasaki Disease (KD) patients with IVIG plus Infliximab, which reduces the need for additional therapies and the duration of treatment,” said Pei Ni Jone, MD, cardiologist, director of the Kawasaki Disease Clinic at Children’s Colorado and co-author of the study. “All MIS-C patients at Children’s Colorado, who are typically more ill than KD patients, are now being treated with an initial dual therapy to improve overall outcomes.”

Journal reference:

Cole, L.D., et al. (2021) IVIG Compared to IVIG Plus Infliximab in Multisystem Inflammatory Syndrome in Children. Pediatrics. doi.org/10.1542/peds.2021-052702.

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