“ 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 alone . The rest had gotten dual therapy .”
What ’ s more , the 52 patients 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 therapy did better by every measure ( 1 ). The data was so strong the team has since implemented dual therapy into the protocol for every patient diagnosed with MIS-C .
It ’ s a departure from convention , not only in aggressiveness but also in 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 , concluded there wasn ’ t any difference ( 3 ).
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 Multisystem Inflammatory Syndrome in Children . Pediatrics . 2021 Sep 21 .
2 . Son MBF , Murray N , Friedman 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 , Schwartz SP , Irby K , Bradford TT , 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 MM , Randolph AG ; Overcoming COVID-19 Investigators . Multisystem Inflammatory Syndrome in Children - Initial 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 .