Could Corticosteroid Monotherapy Be a Safe, Lifesaving Option for MIS-C?

Thousands of cases of multisystem inflammatory syndrome in children (and dozens of resultant deaths) moved COVID-19 infection among pediatric patients from “no big deal” to cause for serious concern. It didn’t take long for intravenous immunoglobulin (IVIG) plus corticosteroids to emerge as a viable treatment. The question of whether that was the best option followed shortly thereafter—with the answer being not necessarily, according to an article just published by JAMA Pediatrics. The retrospective cohort study compared IVIG plus corticosteroids vs corticosteroids alone in 215 children with confirmed COVID-19, with a primary outcome of failure of initial therapy and secondary outcomes including presence of complications, cardiovascular outcomes, fever duration, length of hospital and ICU stays, corticosteroid use duration, and need for readmission. Children in the IVIG + corticosteroids group had longer inpatient stays (6 days vs 5 days for the only-corticosteroid group) and longer median duration of corticosteroid use (10 days vs 5 days), with 71% recovering after corticosteroid monotherapy of 10 days or less. For a pediatric urgent care perspective on MIS-C, read Multisystem Inflammatory Syndrome in Children (MIS-C): Who Should Not Be MISC’ed? in our archive right now.