Combination Immune Therapies for Acute Management of Mis-C and Longterm Outcomes

ABSTRACT

INTRODUCTION: Since the recognition of Multisystem Inflammatory Syndrome in Children (MIS-C), different immune therapies have been utilized as monotherapy (MT) or combination therapy (CT). Currently there is a lack of sufficient literature examining the long-term cardiac and functional outcomes in children following MT versus CT for MIS-C. METHOD(S) We conducted a retrospective chart review of children < 21 years old admitted to our tertiary care children's hospital for MIS-C from January 2020 to January 2022. We collected clinical data, especially cardiac imaging data [left ventricular ejection fraction (LVEF), coronary artery dilation (CAD)], and functional status scores (FSS) during hospital stay and long-term (up to 6 months) follow up. We then compared the long-term outcomes of children who received three different treatment regimens during hospitalization Steroid only (S), Steroid and IVIg (S + IVIg), and Steroid, IVIg, and Anakinra (S + IVIg + Ana), using a student t-test and Fisher's exact test. RESULT(S) Of the 40 children admitted with MIS-C during the study period, one who did not receive any immune therapy was excluded and of the remaining 39, the number of patients in each treatment group (S, S+IVIg, S+IVIg+Ana) was 13 (33%), 14 (36%) and 12 (31%) respectively. During hospitalization, among the S, S+IVIg, and S+IVIg+Ana groups, the mean (SD) LVEF were 63.9 (4.9)%, 60.0 (7.2)%, 55.9 (9.1)% respectively and CAD was documented in 1/11 (9.1%), 3/14 (21.4%) and 2/11 (18.2%) patients, respectively and at up to 6-month follow-up, the mean (SD) LVEF were 63.9 (2.8)%, 63.5 (4.0)%, and 66.3 (3.1)%, respectively, and CAD was documented in 0/11 (0%), 0/10 (0%), 2/10 (20%) patients, respectively. There was no significant difference in the proportion of patients with persistent low (<= 55%) LVEF or CAD across the groups at long-term follow-up (p>0.05). There was no significant difference in DELTAFSS across the 3 groups at discharge [mean (SD) S 0 (0), S+IVIg 0.3 (1.1), and S+IVIg+Ana 0.3 (0.9)] as well as at follow-up [mean (SD) S 0 (0), S+IVIg 0 (0), and S+IVIg+Ana 0.3 (0.7)]. CONCLUSION(S) In our cohort of MIS-C patients, cardiac and functional outcomes were favorable at follow-up irrespective of combination of immune therapies offered during hospitalization.