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). |