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Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes
BACKGROUND: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospit...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Massachusetts Medical Society
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220972/ https://www.ncbi.nlm.nih.gov/pubmed/34133855 http://dx.doi.org/10.1056/NEJMoa2102605 |
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author | Son, Mary Beth F. Murray, Nancy Friedman, Kevin Young, Cameron C. Newhams, Margaret M. Feldstein, Leora R. Loftis, Laura L. Tarquinio, Keiko M. Singh, Aalok R. Heidemann, Sabrina M. Soma, Vijaya L. Riggs, Becky J. Fitzgerald, Julie C. Kong, Michele Doymaz, Sule Giuliano, John S. Keenaghan, Michael A. Hume, Janet R. Hobbs, Charlotte V. Schuster, Jennifer E. Clouser, Katharine N. Hall, Mark W. Smith, Lincoln S. Horwitz, Steven M. Schwartz, Stephanie P. Irby, Katherine Bradford, Tamara T. Maddux, Aline B. Babbitt, Christopher J. Rowan, Courtney M. McLaughlin, Gwenn E. Yager, Phoebe H. Maamari, Mia Mack, Elizabeth H. Carroll, Christopher L. Montgomery, Vicki L. Halasa, Natasha B. Cvijanovich, Natalie Z. Coates, Bria M. Rose, Charles E. Newburger, Jane W. Patel, Manish M. Randolph, Adrienne G. |
author_facet | Son, Mary Beth F. Murray, Nancy Friedman, Kevin Young, Cameron C. Newhams, Margaret M. Feldstein, Leora R. Loftis, Laura L. Tarquinio, Keiko M. Singh, Aalok R. Heidemann, Sabrina M. Soma, Vijaya L. Riggs, Becky J. Fitzgerald, Julie C. Kong, Michele Doymaz, Sule Giuliano, John S. Keenaghan, Michael A. Hume, Janet R. Hobbs, Charlotte V. Schuster, Jennifer E. Clouser, Katharine N. Hall, Mark W. Smith, Lincoln S. Horwitz, Steven M. Schwartz, Stephanie P. Irby, Katherine Bradford, Tamara T. Maddux, Aline B. Babbitt, Christopher J. Rowan, Courtney M. McLaughlin, Gwenn E. Yager, Phoebe H. Maamari, Mia Mack, Elizabeth H. Carroll, Christopher L. Montgomery, Vicki L. Halasa, Natasha B. Cvijanovich, Natalie Z. Coates, Bria M. Rose, Charles E. Newburger, Jane W. Patel, Manish M. Randolph, Adrienne G. |
author_sort | Son, Mary Beth F. |
collection | PubMed |
description | BACKGROUND: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. RESULTS: A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score–matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score–matched analysis. CONCLUSIONS: Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.) |
format | Online Article Text |
id | pubmed-8220972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Massachusetts Medical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-82209722021-06-28 Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes Son, Mary Beth F. Murray, Nancy Friedman, Kevin Young, Cameron C. Newhams, Margaret M. Feldstein, Leora R. Loftis, Laura L. Tarquinio, Keiko M. Singh, Aalok R. Heidemann, Sabrina M. Soma, Vijaya L. Riggs, Becky J. Fitzgerald, Julie C. Kong, Michele Doymaz, Sule Giuliano, John S. Keenaghan, Michael A. Hume, Janet R. Hobbs, Charlotte V. Schuster, Jennifer E. Clouser, Katharine N. Hall, Mark W. Smith, Lincoln S. Horwitz, Steven M. Schwartz, Stephanie P. Irby, Katherine Bradford, Tamara T. Maddux, Aline B. Babbitt, Christopher J. Rowan, Courtney M. McLaughlin, Gwenn E. Yager, Phoebe H. Maamari, Mia Mack, Elizabeth H. Carroll, Christopher L. Montgomery, Vicki L. Halasa, Natasha B. Cvijanovich, Natalie Z. Coates, Bria M. Rose, Charles E. Newburger, Jane W. Patel, Manish M. Randolph, Adrienne G. N Engl J Med Original Article BACKGROUND: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. RESULTS: A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score–matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score–matched analysis. CONCLUSIONS: Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.) Massachusetts Medical Society 2021-06-16 /pmc/articles/PMC8220972/ /pubmed/34133855 http://dx.doi.org/10.1056/NEJMoa2102605 Text en Copyright © 2021 Massachusetts Medical Society. All rights reserved. http://www.nejmgroup.org/legal/terms-of-use.htm This article is made available via the PMC Open Access Subset for unrestricted re-use, except commercial resale, and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the Covid-19 pandemic or until revoked in writing. Upon expiration of these permissions, PMC is granted a license to make this article available via PMC and Europe PMC, subject to existing copyright protections. |
spellingShingle | Original Article Son, Mary Beth F. Murray, Nancy Friedman, Kevin Young, Cameron C. Newhams, Margaret M. Feldstein, Leora R. Loftis, Laura L. Tarquinio, Keiko M. Singh, Aalok R. Heidemann, Sabrina M. Soma, Vijaya L. Riggs, Becky J. Fitzgerald, Julie C. Kong, Michele Doymaz, Sule Giuliano, John S. Keenaghan, Michael A. Hume, Janet R. Hobbs, Charlotte V. Schuster, Jennifer E. Clouser, Katharine N. Hall, Mark W. Smith, Lincoln S. Horwitz, Steven M. Schwartz, Stephanie P. Irby, Katherine Bradford, Tamara T. Maddux, Aline B. Babbitt, Christopher J. Rowan, Courtney M. McLaughlin, Gwenn E. Yager, Phoebe H. Maamari, Mia Mack, Elizabeth H. Carroll, Christopher L. Montgomery, Vicki L. Halasa, Natasha B. Cvijanovich, Natalie Z. Coates, Bria M. Rose, Charles E. Newburger, Jane W. Patel, Manish M. Randolph, Adrienne G. Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title | Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title_full | Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title_fullStr | Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title_full_unstemmed | Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title_short | Multisystem Inflammatory Syndrome in Children — Initial Therapy and Outcomes |
title_sort | multisystem inflammatory syndrome in children — initial therapy and outcomes |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220972/ https://www.ncbi.nlm.nih.gov/pubmed/34133855 http://dx.doi.org/10.1056/NEJMoa2102605 |
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