Safety and Efficacy of Pharmacological Treatments Available for Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review

Velusamy, Yasothaa (2022) Safety and Efficacy of Pharmacological Treatments Available for Multisystem Inflammatory Syndrome in Children (MIS-C): A Systematic Review. [Project Paper] (Submitted)

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Abstract

In early April 2020, rare cases associated with SARS-CoV-2 were reported in children known as Multisystem Inflammatory Syndrome in Children (MIS-C). However, this emergence resulted in lack of studies and evidence-based suggestions for its pharmacological approaches for MIS-C. Objectives: This study aims to describe the existing pharmacological management for MIS-C systematically, identify the available pharmacological managements, evaluate its safety and efficacy, and identify the best treatment procedures. Methodology: A systematic search via EBSCOhost and Scopus databases was conducted on August 18, 2021, using the terminologies children, MIS-C/PIMS, and SARS-CoV-2. A PRISMA flow diagram was used to report the study selection process. Newcastle-Ottawa Scale (NOS) and GRADE tools were used for quality analysis process. Data synthesis was done by extracting the information on treatments used, efficacy and side effects. Results: From the included 28 articles, 2128 children with MIS-C were studied. The main pharmacological approaches were immunomodulatory therapy; intravenous immunoglobulin (IVIG) (78.2%); steroids (58%); a combination of IVIG and steroids (40.1%). IVIG and steroids were found to be potentially effective and safe for MIS-C. A combination of IVIG and steroids was found favourable in severe cases with a higher recovery rate. Refractory treatments include a second dose of initial treatment and biological response modifier drugs (BRMDs) like anakinra and tocilizumab. Supportive treatment consisted of vasoactive, inotropic, and anticoagulation. The mortality rate was 1.27%, and only three studies reported side effects from the treatments. Evidence of outcome from GRADE were mostly at moderate, low and very low level while NOS had a mean score of 6.5. Discussion: The main treatments consist of immunomodulatory therapy aimed at decreasing tissue inflammation. Supportive management aid in lessening acute life-threatening complications and preventing coronary artery aneurysm. IVIG is used as the standard treatment. However, MIS-C has a refractory nature that most children require second-line treatment with corticosteroids and BRMDs. Conclusion: This review provides preliminary evidence to support the current standard treatment practices in managing MIS-C pharmacologically. However, clinical trials required for comprehensive investigation to provide stronger outcome evidence.

Item Type:	Project Paper
Faculty:	Faculty of Medicine and Health Science
Depositing User:	Ms. Nor Safa'aton Saidin
Date Deposited:	22 Aug 2023 07:04
Last Modified:	22 Aug 2023 07:04
URI:	http://psaspb.upm.edu.my/id/eprint/1385

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