Anti-inflammatory agents, including corticosteroids and intravenous immune globulin (IVIG), serve an important role in the treatment of severe pediatric cases of COVID-19, according to a study published in the Journal of Family Medicine and Primary Care. IVIG also has an important therapeutic role in cases with multisystem inflammatory syndrome in children (MIS-C), the researchers said.
The study consisted of a metanalysis of 97 case studies evaluating the management of COVID-19 cases in children with 18 shortlisted medications. These articles contained information on the treatment modalities in a total of 8243 children. Twelve percent of the cases described in the studies were asymptomatic, while 39% were mild, 28% were moderate, and 21% were in the severe/critical category. Overall mortality was 1.3%, while mortality among patients with moderate to severe disease was 4.6%.
According to the investigators, 91% of severe pediatric cases received some anti-inflammatory medications, with 17.5% receiving IVIG and 17% receiving corticosteroids. The investigators found that 79% of children in these studies were managed conservatively or with symptomatic treatment alone, with the remaining 21% receiving at least 1 medication specifically used for COVID-19.
In a subgroup analysis of 27 studies with at least 20 MIS-C patients, which included a total of 917 patients, 79% of patients required intensive care unit admission, 33% required mechanical ventilation, and 6% required extracorporeal membrane oxygenation. The predominant therapy among patients under 14 years of age with MIS-C was IVIG, used in 81% of cases, followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulants (56%).
The study authors noted a significant heterogeneity among the studies reviewed, with a large number of different treatment options in use. For example, while antivirals were used in 15.3% of children, the antivirals used across studies included remedesivir, favipiravir, oseltamivir, ritonavir/lopinavir, ribavirin, and umifenavir. They also suggest the possibility that the common usage of corticosteroids and IVIG might be due to the fact that the majority of the publications describing children with severe illness included children with MIS-C-like presentation.
Panda PK, Sharaway IK, Natarajan V, Bhakat R, Panda P, Dawman L. COVID-19 treatment in children: A systematic review and meta-analysis. J Family Med Prim Care. 2021 Sep; 10(9): 3292–3302. doi:10.4103/jfmpc.jfmpc_2583_20