COVID-19 NEWS |
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The Case for Two continued |
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and Prevention and the World Health Organization , among others , but went a step further .
Children ’ s Colorado ’ s protocol was the first in the nation to include routine echocardiography for every suspected case , crucial for catching cardiac inflammation .
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INFLIXIMAB VERSUS STEROIDS
Starting in December of 2020 ,
the team also added , for the
sickest patients , another
intravenous therapy to the
IVIG regimen : infliximab , a labgrown
antibody that blocks the
production of tumor necrosis
factor alpha , or TNF .
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“ We had four initial criteria : If they were in shock , they needed pressure support , they had dilated coronary arteries and they had ventricular dysfunction , we ’ d give them infliximab ,” says Dr . Jone . “ But when we looked back in February 2021 at the 72 patients we ’ d treated since December 2020 , we realized only 20 had received IVIG |
Dr . Jone believes TNF blockers
are a more intuitive treatment
either way : The course of
steroid treatment lasts six
weeks . Infliximab requires just one intravenous dose . •
1 . Cole LD , Osborne CM , Silveira
LJ , Rao S , Lockwood JM , Kunkel
MJ , MacBrayne CE , Heizer
HR , Anderson MS , Jone PN ,
Dominguez SR . IVIG Compared
to IVIG Plus Infliximab in
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alone . The rest had gotten dual therapy .” |
Multisystem Inflammatory
Syndrome in Children . Pediatrics .
2021 Sep 21 .
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What ’ s more , the 52 patients |
2 . Son MBF , Murray N , Friedman |
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who ’ d received both therapies had better outcomes . They recovered faster . They required less additional therapy . In fact , a retrospective study the team published in Pediatrics showed patients who received dual |
K , Young CC , Newhams MM ,
Feldstein LR , Loftis LL , Tarquinio
KM , Singh AR , Heidemann SM ,
Soma VL , Riggs BJ , Fitzgerald JC ,
Kong M , Doymaz S , Giuliano JS Jr ,
Keenaghan MA , Hume JR , Hobbs
CV , Schuster JE , Clouser KN ,
Hall MW , Smith LS , Horwitz SM ,
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therapy did better by every |
Schwartz SP , Irby K , Bradford TT , |
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measure ( 1 ). The data was so strong the team has since implemented dual therapy into the protocol for every patient diagnosed with MIS-C . |
Maddux AB , Babbitt CJ , Rowan
CM , McLaughlin GE , Yager PH ,
Maamari M , Mack EH , Carroll
CL , Montgomery VL , Halasa
NB , Cvijanovich NZ , Coates BM ,
Rose CE , Newburger JW , Patel
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It ’ s a departure from convention , not only in aggressiveness but also in |
MM , Randolph AG ; Overcoming
COVID-19 Investigators .
Multisystem Inflammatory
Syndrome in Children - Initial
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protocol . Most centers have employed steroids as a second course of treatment to IVIG ; the New England Journal of Medicine published a study in the summer of 2021 showing an association between treatment with IVIG plus glutocorticoids and lower risk of cardiovascular dysfunction ( 2 ). But another study , published in the same issue , |
Therapy and Outcomes . N Engl J
Med . 2021 Jul 1 ; 385 ( 1 ): 23-34 .
3 . McArdle AJ , Vito O , Patel H ,
Seaby EG , Shah P , Wilson C ,
Broderick C , Nijman R , Tremoulet
AH , Munblit D , Ulloa-Gutierrez
R , Carter MJ , De T , Hoggart C ,
Whittaker E , Herberg JA , Kaforou
M , Cunnington AJ , Levin M ;
BATS Consortium . Treatment
of Multisystem Inflammatory
Syndrome in Children . N Engl J
Med . 2021 Jul 1 ; 385 ( 1 ): 11-22 .
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concluded there wasn ’ t any |
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difference ( 3 ). |