IVIG Plus Glucocorticoids Superior to IVIG Alone for MIS-C Associated with COVID-19: Review and Meta-Analysis

While the etiology and pathogenesis of multisystem inflammatory syndrome (MIS-C) in children associated with SARS-CoV-2 infection remains unclear, the resemblance of its manifestations to Kawasaki disease has prompted use of intravenous immune globulin (IVIG) alone or in combination with glucocorticoids. Given the absence of a consensus or guidelines to guide optimal treatment of MIS-C with these agents, U.S. and Nepalese collaborators performed a systematic review and meta-analysis of qualifying studies conducted from January 2020 to August 2021.

Three studies, which cumulatively enrolled 756 pediatric patients less than 21 years of age, were included in the final quantitative analysis. Initial therapy with IVIG plus glucocorticoids significantly lowered the risk of treatment failure relative to IVIG therapy alone (odds ratio [OR] 0.57; 95% confidence interval [CI] 0.42 to 0.79; I2 45.36%) and the need for adjunctive immunomodulatory therapy (OR 0.27; 95% CI 0.20, 0.37; I2 0.0%). The combination therapy was not associated with a reduction in occurrence of ventricular dysfunction (OR 0.79; 95% CI 0.34 to 1.87, I2 58.44%) or the need for inotropic support (OR 0.83; 95% CI, 0.35 to 1.99, I2 75.40%).

“This study supports the use of IVIG with glucocorticoids compared to IVIG alone, as the combination therapy significantly lowered the risk of treatment failure and the need for adjunctive immunomodulatory therapy,” the investigators concluded.