Researchers Propose New Treatment Guidelines for MIS-C in Kids

Over the past year, doctors scrambled to figure out multisystem inflammatory syndrome in children (MIS-C), a new health condition associated with COVID-19. Now, researchers have proposed new guidelines to help guide doctors across the country on treating the condition.

The proposed guidelines, which were published in the New England Journal of Medicine in July, analyzed the treatment and outcomes of 518 patients with MIS-C who had been admitted to one of 58 hospitals across the country between March 15 and October 31, 2020.

The researchers discovered that 31% of patients who were treated with intravenous immune globulin (IVIG), a concentrated solution of antibodies, had new or persistent heart issues on the second day of treatment or after that.

But only 17% of those who were given IVIG along with glucocorticoids, a class of corticosteroids that tackle inflammation in the body, experienced the same heart complications.

Only 34% of patients who received IVIG and glucocorticoids also needed additional treatment like medications for low blood pressure and immunomodulatory drugs on the first day in the hospital or afterward, compared to 70% of the IVIG-only patients.

The conclusion, researchers said, is that “among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone.”

“Our study, along with other recent contributions to the literature, provide clinicians with more of an evidence base to treat children with MIS-C,” lead study author Mary Beth F. Son, MD, associate professor of pediatrics at Harvard Medical School, tells Verywell. “We hope that our findings—that patients who meet the Centers for Disease Control and Prevention (CDC) definition of MIS-C have better short term cardiovascular outcomes as compared to children treated with IVIG alone—will assist clinicians with management decisions.”

Existing MIS-C Treatment Recommendations

Initial treatment guidelines for MIS-C have already been published by the American College of Rheumatology. Those guidelines give providers a flow chart to follow, including tests to run, that may lead to a MIS-C diagnosis.

The guidance also breaks down treatment by whether a patient has a shock or organ-threatening disease. If they do, the American College of Rheumatology recommends treating the patient with IVIG, along with methylprednisolone “or another steroid.”

However, the authors of the guidelines acknowledge that MIS-C treatments are still being investigated.

“It is the ultimate goal of both the ACR and the Task Force panelists to disseminate knowledge quickly in an effort to improve outcomes for children with SARS-CoV-2 infections,” the guidance reads.

What Do Doctors Think Of the Guidelines?

“It’s a great study,” Juan Salazar, MD, MPH, a pediatric infectious disease specialist and physician in chief at Connecticut Children's, tells Verywell. “But it’s not a randomized control trial, so it has limitations.” Salazar points out the patients who also received steroid medications in addition to IVIG may have had more severe forms of MIS-C.

Still, he says, “the conclusions make sense that this combination would be beneficial.”

Daniel Ganjian, MD, a pediatrician at Providence Saint John’s Health Center in California, tells Verywell that the proposed guidelines are “a step in the right direction, but they’re not the final step.”

“We still need to find out if there are other ways to regulate the immune response, and we still need to do more testing to figure out the best method,” he says.

Salazar says that clear guidance is needed for doctors across the country. “This is a new disease. We had not seen MIS-C in our history until May of 2020,” he says, pointing out that doctors have historically treated MIS-C similar to the way they treat Kawasaki disease, a condition that causes inflammation of the blood vessels.  “At least we now have some evidence that this works,” he adds.

Son agrees that more research is needed. “Many questions remain regarding treatment in MIS-C,” she says. “First, the indications for treatment are not clearly determined. It is possible that mild cases do not need treatment. However, based on our recent study, we would recommend treatment with IVIG and steroids for any patient with MIS-C who is significantly ill and/or has signs of cardiac dysfunction or dangerously low blood pressures.”

There have also been no randomized clinical trials of IVIG’s effectiveness in treating MIS-C, she points out.

“I do think that we will learn more about treatment in the coming months, although we all hope that widespread vaccination, critical to our ability to curb infections with SARS CoV-2 and end the pandemic, will lead to less MIS-C as well,” Son says.

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