| Autor: |
Tagarro, Alfredo, Domínguez-Rodríguez, Sara, Mesa, Juan Miguel, Epalza, Cristina, Grasa, Carlos, Iglesias-Bouzas, María Isabel, Fernández-Cooke, Elisa, Calvo, Cristina, Villaverde, Serena, Torres-Fernández, David, Méndez-Echevarria, Ana, Leoz, Inés, Fernández-Pascual, María, Saavedra-Lozano, Jesús, Soto, Beatriz, Aguilera-Alonso, David, Rivière, Jacques G, Fumadó, Victoria, Martínez-Campos, Leticia, Vivanco, Ana, Pilar-Orive, Francisco Javier, Alcalá, Pedro, Ruiz, Beatriz, López-Machín, Ana, Oltra, Manuel, Moraleda, Cinta, EPICO Working Group |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
European journal of pediatrics. |
| ISSN: |
1432-1076 |
| Popis: |
Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG. Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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