Multisystem Inflammatory Syndrome Therapies in Children: A Comparative Effectiveness Trial.
Sonia Jain, Feng He, Yuwei Cheng et al.
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In 30 seconds
This two-hospital comparative effectiveness trial evaluated infliximab, methylprednisolone, and anakinra in children with intravenous immunoglobulin (IVIG)-resistant multisystem inflammatory syndrome (MIS-C). Among 71 children who received their first randomized treatment and completed the study, the adjusted odds of needing a second randomization were higher with anakinra than with infliximab (OR = 3.42, 95% CI: 1.03-12.29, P = .049); the odds were similar with steroids and infliximab. The findings suggest infliximab or steroids may be more effective than anakinra as adjunctive therapy, while adverse events were not serious.
Key findings
- Adjusted odds of needing second randomization were 3.42 times higher with anakinra than infliximab (95% CI: 1.03-12.29, P = .049).
- The odds of needing second randomization were similar with steroids and infliximab.
- Twenty-eight adverse events were recorded; none were serious, and 16 of 17 treatment-related events were attributed to steroids.
Why it matters
IVIG-resistant MIS-C may require additional anti-inflammatory treatment. In this comparative trial, anakinra was associated with greater odds of needing another randomization than infliximab, while steroids and infliximab had similar odds. These results inform the comparative evidence for adjunctive options, but the study’s outcome reflects the need for further treatment rather than a direct measure of long-term recovery.
What to keep in mind
The study was conducted at two hospitals, and the primary outcome was need for second randomization rather than a long-term clinical outcome.