Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children.
Details
Serval ID
serval:BIB_F643F19359A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children.
Journal
JAMA
Working group(s)
French Covid-19 Paediatric Inflammation Consortium
Contributor(s)
Rames C., Donzeau A., Lety S., Fedorczuk C., Lajus M., Bensaid P., Laoudi Y., Pons C., Beaucourt C., De Pontual L., Aupiais C., Lefevre-Utile A., Richard M., Goisque E., Iriart X., Brissaud O., Bailhache M., Segretin P., Molimard J., Orcel M.C., Benoist G., Amouyal E., Guerder M., Pouyau R., De Guillebon De Resnes J.M., Mezgueldi E., Cour-Andlauer F., Horvat C., Poinsot P., Frachette C., Ouziel A., Gillet Y., Barrey C., Brouard J., Faucon C., Ginies H., Ro V., Elanga N., Gajdos V., Basmaci R., Danekova N., Mutar H., Rouget S., Torterüe X., Nattes E., Hau I., Biscardi S., El Jurdi H., Jung C., Epaud R., Delestrain C., Carlier-Gonod A., Chavy C., Colomb B., Litzler-Renault S., Semama D., Huet F., Sarakbi M., Mortamet G., Bost-Bru C., Kevorkian-Verguet C., Lachaud M., Vinit C., Hentgen V., Leroux P., Bertrand V., Parrod C., Craiu I., Kone-Paut I., Durand P., Tissiere P., Morin L., Miatello J., Morelle G., Guiddir T., Borocco C., Guillot C., Leteurtre S., Dubos F., Jouancastay M., Recher M., Martinot A., Voeusler V., Languepin J., Morand A., Bosdure E., Bresson V., Vanel N., Ughetto F., Michel F., Marie C., Blonde R., Nguyen J., Garrec N., Chalvon-Demersay A., Masserot-Lureau C., Colas A.S., Ferrua C., Larakeb A., Benkaddouss S., Mathivon L., Monfort M., Naji S., Carbasse A., Milesi C., Schweitzer C., Giroux N., Boussard N., Romefort B., Launay E., Gras-Le Guen C., Ali A., Blot N., Tran A., Rancurel A., Haas H., Afanetti M., Bernardor J., Talmud D., Jhaouat I., Monceaux F., Chosidow A., Romain A.S., Grimprel E., Rambaud J., Jean S., Starck J., Levy Y., Guedj R., Carbajal R., Parisot P., Poncelet G., Wolff R., Lacarra B., Maroni A., Naudin J., Geslin G., Maurice L., Deho A., Lebourgeois F., Chomton M., Dauger S., Genuini M., Benzouid C., Lokmer J., Bonnefoy R., Melki I., Dingulu G., Gaschignard J., Ducrocq C., Pouletty M., Corseri O., Faye A., Rybak A., Titomanlio L., Hurtaux M.F., Garcelain G., Bonacorsi S., Bidet P., Birgy A., Renolleau S., Lesage F., Moulin F., Dupic L., de Saint Blanquat L., Heilbronner C., Vedrenne-Cloquet M., Salvador E., Bendavid M., De Marcellus C., Chareyre J., Pinhas Y., Brisse J., Taylor M., Debray A., Adnot P., Chalumeau M., Abadie V., Frange P., Cohen J.F., Curtis W., Chappuy H., Belhadjer Z., Auriau J., Méot M., Houyel L., Bonnet D., Delacourt C., Drummond D., Bader-Meunier B., Quartier P., Delion F., Blanc P., Caron E., Maledon N., Robert B., Pantalone L., Kouider H., Loeile C., Loron G., Vittot C., Blanc T., Pinquier D., Buisson F., Flodrops H., Karim J.B., Sarton R., Mokraoui F., Escoda S., Deschamps N., Bonnemains L., Mahi S.L., Mertes C., Terzic J., Idier C., Benezech A., Simon T., Decramer S., Karsenty C., Brehin C., Chenichene S., Ursulescu N.M., Manteau C., Delattre M., Dalichoux B.
ISSN
1538-3598 (Electronic)
ISSN-L
0098-7484
Publication state
Published
Issued date
02/03/2021
Peer-reviewed
Oui
Volume
325
Number
9
Pages
855-864
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with severe acute respiratory syndrome coronavirus 2 infection, potentially life-threatening, but the optimal therapeutic strategy remains unknown.
To compare intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone as initial therapy in MIS-C.
Retrospective cohort study drawn from a national surveillance system with propensity score-matched analysis. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the World Health Organization definition were included. The study started on April 1, 2020, and follow-up ended on January 6, 2021.
IVIG and methylprednisolone vs IVIG alone.
The primary outcome was persistence of fever 2 days after the introduction of initial therapy or recrudescence of fever within 7 days, which defined treatment failure. Secondary outcomes included a second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit. The primary analysis involved propensity score matching with a minimum caliper of 0.1.
Among 181 children with suspected MIS-C, 111 fulfilled the World Health Organization definition (58 females [52%]; median age, 8.6 years [interquartile range, 4.7 to 12.1]). Five children did not receive either treatment. Overall, 3 of 34 children (9%) in the IVIG and methylprednisolone group and 37 of 72 (51%) in the IVIG alone group did not respond to treatment. Treatment with IVIG and methylprednisolone vs IVIG alone was associated with lower risk of treatment failure (absolute risk difference, -0.28 [95% CI, -0.48 to -0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = .008). IVIG and methylprednisolone therapy vs IVIG alone was also significantly associated with lower risk of use of second-line therapy (absolute risk difference, -0.22 [95% CI, -0.40 to -0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = .004), hemodynamic support (absolute risk difference, -0.17 [95% CI, -0.34 to -0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, -0.18 [95% CI, -0.35 to -0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]), and duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; difference in days, -2.4 [95% CI, -4.0 to -0.7]).
Among children with MIS-C, treatment with IVIG and methylprednisolone vs IVIG alone was associated with a more favorable fever course. Study interpretation is limited by the observational design.
To compare intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone as initial therapy in MIS-C.
Retrospective cohort study drawn from a national surveillance system with propensity score-matched analysis. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the World Health Organization definition were included. The study started on April 1, 2020, and follow-up ended on January 6, 2021.
IVIG and methylprednisolone vs IVIG alone.
The primary outcome was persistence of fever 2 days after the introduction of initial therapy or recrudescence of fever within 7 days, which defined treatment failure. Secondary outcomes included a second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit. The primary analysis involved propensity score matching with a minimum caliper of 0.1.
Among 181 children with suspected MIS-C, 111 fulfilled the World Health Organization definition (58 females [52%]; median age, 8.6 years [interquartile range, 4.7 to 12.1]). Five children did not receive either treatment. Overall, 3 of 34 children (9%) in the IVIG and methylprednisolone group and 37 of 72 (51%) in the IVIG alone group did not respond to treatment. Treatment with IVIG and methylprednisolone vs IVIG alone was associated with lower risk of treatment failure (absolute risk difference, -0.28 [95% CI, -0.48 to -0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = .008). IVIG and methylprednisolone therapy vs IVIG alone was also significantly associated with lower risk of use of second-line therapy (absolute risk difference, -0.22 [95% CI, -0.40 to -0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = .004), hemodynamic support (absolute risk difference, -0.17 [95% CI, -0.34 to -0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, -0.18 [95% CI, -0.35 to -0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]), and duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; difference in days, -2.4 [95% CI, -4.0 to -0.7]).
Among children with MIS-C, treatment with IVIG and methylprednisolone vs IVIG alone was associated with a more favorable fever course. Study interpretation is limited by the observational design.
Keywords
Adolescent, COVID-19/complications, COVID-19/therapy, Child, Child, Preschool, Combined Modality Therapy, Female, Fever/etiology, France, Glucocorticoids/adverse effects, Glucocorticoids/therapeutic use, Humans, Immunoglobulins, Intravenous/therapeutic use, Intensive Care Units, Pediatric, Length of Stay, Male, Methylprednisolone/adverse effects, Methylprednisolone/therapeutic use, Propensity Score, Recurrence, Retrospective Studies, Systemic Inflammatory Response Syndrome/complications, Systemic Inflammatory Response Syndrome/drug therapy, Systemic Inflammatory Response Syndrome/therapy, Treatment Outcome, COVID-19 Drug Treatment
Pubmed
Web of science
Open Access
Yes
Create date
11/12/2024 10:26
Last modification date
13/12/2024 9:07
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