Comparison of the Efficacy of Intravenous Immunoglobulin with Methylprednisolone as First-line Therapy in Multisystem Inflammatory Syndrome in Children: A Prospective Cohort Study

Aims and background: Comparison of the efficacy of methylprednisolone with intravenous immunoglobulin (IVIG) as first-line therapy in multisystem inflammatory syndrome in children (MIS-C). Multisystem inflammatory syndrome in children is thought to be postinfectious immune dysregulation and needs immunomodulatory therapy. Current guidelines suggest the concomitant use of steroids and immunoglobulins as first-line therapy. However, the efficacy of these interventions is still under analysis, and we require more analytical and experimental studies to formulate definitive treatment. Materials and methods: This prospective cohort study was carried out between August 2021 and July 2022. Children aged 1 month to 14 years satisfying World Health Organization (WHO) criteria for MIS-C were enrolled. They were categorized into IVIG group and methylprednisolone group based on the drug they received as the first-line monotherapy for MIS-C. The outcome was measured as a resolution of fever and shock within 48 hours of starting initial therapy and duration of PICU stay. Data were analyzed using Microsoft Excel and SPSS version 26. Chi-squared tests were used for categorical data. Student <i>t</i>-test, Mann–Whitney test, and Kruskal–Wallis tests were used for comparison. Results: Out of 66 qualified children, 51 children received drug therapy, as 7 children required only supportive treatment. Thirty received IVIG, 21 children received methylprednisolone, and those presenting with severe symptoms (<i>n</i> = 15) received both IVIG and methylprednisolone. The methylprednisolone group had significantly shorter resolution time for shock (mean = 20 hours) than the IVIG group (mean = 23.27 hours) (<i>p</i> = 0.023). However, the duration of PICU stay was longer for the methylprednisolone group (median = 5 days) than the IVIG group (median = 4 days) (<i>p</i> = 0.001), and there was no significant difference in the time for resolution of fever (<i>p</i> = 0.563). Conclusion: The duration of resolution of shock was shorter and the duration of ICU stay was longer in the methylprednisolone group compared to the IVIG group. Though statistically significant, as the duration of resolution of shock was not clinically significant, it was concluded that no significant difference in outcome was observed between the two groups. Clinical significance: As the sample size is small and the results are not clinically significant, no conclusions can be drawn from our study. We recommend that more research is necessary to demonstrate the efficacy of IVIG or methylprednisolone as monotherapy in MIS-C.