Corticosteroids, IVIG help reduce risk of aneurysm in children with MIS-C

The use of corticosteroids, intravenous immunoglobulin (IVIG), and their combination appear to protect children with multisystem inflammatory syndrome (MIS-C) against aneurysm compared with no immunomodulatory treatment, suggests a study.

A total of 853 hospitalized patients aged 0–18 years with MIS-C between March 2020 and June 2023 from cohort in Poland, Spain, Catalonia, and Colombia were included in this multicentre study. Aneurysm risk factors were analysed using logistic regression. 

The investigators assessed treatment efficacy using Kaplan–Meier and Cox proportional hazards model, with post hoc Tukey’s tests for pairwise comparisons.

Of the patients, 33 (4 percent, median age 5.86 years) developed aneurysms. Compared with no treatment, all immunomodulatory regimens reduced the risk of aneurysm: corticosteroids plus IVIG (odds ratio [OR], 0.29, 95 percent confidence interval [CI], 0.13–0.68), corticosteroids alone (OR, 0.27, 95 percent CI, 0.04–1.02), and IVIG alone (OR, 0.49, 95 percent CI, 0.18–1.28).

In Kaplan–Meier analysis, no immunomodulatory treatment was associated with a significantly lower 7-day aneurysm-free probability (92 percent, 95 percent CI, 87–96; p=0.011).

Furthermore, aneurysm risk significantly decreased with corticosteroids plus IVIG (hazard ratio [HR], 0.29, 95 percent CI, 0.13–0.65), corticosteroids alone (HR, 0.25, 95 percent CI, 0.06–1.13), and IVIG alone (HR, 0.49, 95 percent CI, 0.19–1.25). No significant differences were noted between treatments. Moreover, no additional risk factors for aneurysm were found.

“Although the three therapies showed no significant differences when compared with each other, only the combination significantly reduced the risk,” the investigators said. “Corticosteroids may still be a useful option when IVIG is limited.”