Immunomodulatory Therapy for MIS-C

Pediatrics. 2023 Jul 1;152(1):e2022061173. doi: 10.1542/peds.2022-061173.


Context: Studies comparing initial therapy for multisystem inflammatory syndrome in children (MIS-C) provided conflicting results.

Objective: To compare outcomes in MIS-C patients treated with intravenous immunoglobulin (IVIG), glucocorticoids, or the combination thereof.

Data sources: Medline, Embase, CENTRAL and WOS, from January 2020 to February 2022.

Study selection: Randomized or observational comparative studies including MIS-C patients <21 years.

Data extraction: Two reviewers independently selected studies and obtained individual participant data. The main outcome was cardiovascular dysfunction (CD), defined as left ventricular ejection fraction < 55% or vasopressor requirement ≥ day 2 of initial therapy, analyzed with a propensity score-matched analysis.

Results: Of 2635 studies identified, 3 nonrandomized cohorts were included. The meta-analysis included 958 children. IVIG plus glucocorticoids group as compared with IVIG alone had improved CD (odds ratio [OR] 0.62 [0.42-0.91]). Glucocorticoids alone group as compared with IVIG alone did not have improved CD (OR 0.57 [0.31-1.05]). Glucocorticoids alone group as compared with IVIG plus glucocorticoids did not have improved CD (OR 0.67 [0.24-1.86]). Secondary analyses found better outcomes associated with IVIG plus glucocorticoids compared with glucocorticoids alone (fever ≥ day 2, need for secondary therapies) and better outcomes associated with glucocorticoids alone compared with IVIG alone (left ventricular ejection fraction < 55% ≥ day 2).

Limitations: Nonrandomized nature of included studies.

Conclusions: In a meta-analysis of MIS-C patients, IVIG plus glucocorticoids was associated with improved CD compared with IVIG alone. Glucocorticoids alone was not associated with improved CD compared with IVIG alone or IVIG plus glucocorticoids.

Publication types

  • Meta-Analysis

MeSH terms

  • Child
  • Glucocorticoids* / therapeutic use
  • Humans
  • Immunoglobulins, Intravenous* / therapeutic use
  • Immunomodulation
  • Stroke Volume
  • Ventricular Function, Left


  • Glucocorticoids
  • Immunoglobulins, Intravenous

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related