Naim Ouldali (France)

Robert Debré Hospital, APHP, Paris General pediatrics, infectious disease and internal medicine
Dr Ouldali is currently working as senior pediatrician in the general pediatrics and pediatric infectious disease department of Robert Debré university hospital, Paris University, France. The main topic of his PhD was the epidemiology of pneumococcal diseases in children and serotype replacement in PCV13 era. He also took part in assessing SARS-CoV-2 related diseases in children in France, especially clinical and therapeutic aspects of MIS-C.

Presenter of 1 Presentation

 Conference Calendar

IMMUNOGLOBULINS PLUS CORTICOSTEROIDS VS IMMUNOGLOBULINS ALONE IN MIS-C ASSOCIATED WITH SARS-COV-2: A QUASI-EXPERIMENTAL PROPENSITY SCORE MATCHING ANALYSIS BASED ON A FRENCH NATIONAL SURVEILLANCE SYSTEM (ID 1137)

Session Name
2570 - PARALLEL SYMPOSIUM 15: COVID-19 CLINICAL AND TREATMENT  (ID 97)
Lecture Time
13:06 - 13:13
Room
Hall 04
Presenter

Abstract

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric disease associated with SARS-CoV-2 infection, potentially life threatening, but optimal therapeutic strategy remains unknown. We aimed to compare the efficacy of intravenous immunoglobulins (IVIG) plus methylprednisolone versus IVIG alone as first-line therapy.

Methods

We conducted a quasi-randomized propensity score analysis, using a 1:2 matching algorithm, based on a national surveillance system. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the WHO definition were included. The primary outcome was the persistence of fever 2 days after the introduction of first-line therapy or recrudescence of fever within 7 days after the first-line therapy, which defined treatment failure. Secondary outcomes included a requirement for second-line therapy, hemodynamic support, and acute left ventricular dysfunction after first-line therapy.

Results

Among 181 children with suspected MIS-C, 111 fulfilled WHO definition. 37/72 (51%) children in the IVIG alone group and 3/34 (9%) in the IVIG+methylprednisolone group showed treatment failure. In the propensity-score analysis, treatment failure was significantly reduced in the IVIG+methylprednisolone versus IVIG alone group (OR 0.25, 95% CI 0.09 to 0.70], p=0.009). Second-line therapy, hemodynamic support and acute left-ventricular dysfunction occurring after first-line therapy were also significantly reduced in the IVIG+methylprednisolone group (OR 0.19, 95%CI [0.06; 0.61]; OR 0.21, 95%CI [0.06; 0.76]; and OR 0.20, 95%CI [0.06; 0.66], respectively).

Conclusions

IVIG plus methylprednisolone was superior to IVIG alone as first-line therapy in MIS-C.

Hide