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BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue.
McArdle A.J., Vito O., Patel H., Seaby E.G., Shah P., Wilson C., et al. (2021). Treatment of Multisystem Inflammatory Syndrome in Children. THE NEW ENGLAND JOURNAL OF MEDICINE, 385(1), 11-22 [10.1056/NEJMoa2102968].
Treatment of Multisystem Inflammatory Syndrome in Children
McArdle A. J.;Vito O.;Patel H.;Seaby E. G.;Shah P.;Wilson C.;Broderick C.;Nijman R.;Tremoulet A. H.;Munblit D.;Ulloa-Gutierrez R.;Carter M. J.;De T.;Hoggart C.;Whittaker E.;Herberg J. A.;Kaforou M.;Cunnington A. J.;Levin M.;Vazquez J. A.;Carmona R.;Perez L.;Rubinos M.;Veliz N.;Yori S.;Haerynck F.;Hoste L.;Leal I. A.;Da Silva A. R. A.;Silva A. E. A.;Barchik A.;Barreiro S. T. A.;Cochrane N.;Teixeira C. H.;Arauj J. M.;Ossa R. A. P. -D. L.;Vieira C. S.;Dimitrova A.;Ganeva M.;Stefanov S.;Telcharova-Mihaylovska A.;Biggs C. M.;Scuccimarri R.;Withington D.;Raul B. B.;Ampuero C.;Aravena J.;Casanova D.;Cruces P.;Diaz F.;Garcia-Salum T.;Godoy L.;Medina R. A.;Galaz G. V.;Avila-Aguero M. L.;Brenes-Chacon H.;Ivankovich-Escoto G.;Yock-Corrales A.;Badib A.;Badreldin K.;Elkhashab Y.;Heshmat H.;Heinonen S.;Angoulvant F.;Belot A.;Ouldali N.;Beske F.;Heep A.;Masjosthusmann K.;Reiter K.;Heuvel I. V. D.;Both U. V.;Agrafiotou A.;Antachopoulos C.;Eleftheriou I.;Farmaki E.;Fotis L.;Kafetzis D.;Lampidi S.;Liakopoulou T.;Maritsi D.;Michailidou E.;Milioudi M.;Mparmpounaki I.;Papadimitriou E.;Papaevangelou V.;Roilides E.;Tsiatsiou O.;Tsolas G.;Tsolia M.;Vantsi P.;Pineda L. Y. B.;Aguilar K. L. B.;Quintero E. M. C.;Ip P.;Kwan M. Y. W.;Kwok J.;Lau Y. L.;To K.;Wong J. S. C.;David M.;Farkas D.;Kalcakosz S.;Szekeres K.;Zsigmond B.;Aslam N.;Andreozzi L.;Bianco F.;Bucciarelli V.;Buonsenso D.;Cimaz R.;D'Argenio P.;Dellepiane R. M.;Fabi M.;Mastrolia M. V.;Mauro A.;Mazza A.;Romani L.;Simonini G.;Tipo V.;Valentini P.;Verdoni L.;Reel B.;Pace D.;Torpiano P.;Flores M. F.;Dominguez M. G.;Vargas A. L. G.;Hernandez L. L.;Figueroa R. P. M.;Gaxiola G. P.;Valadez J.;Klevberg S.;Knudsen P. K.;Maseide P. H.;Carrera J. M.;Castano E. G.;Timana C. A. D.;Leon T. D.;Estripeaut D.;Levy J.;Norero X.;Record J.;Rojas-Bonilla M.;Iramain R.;Hernandez R.;Huaman G.;Munaico M.;Peralta C.;Seminario D.;Yarleque E. H. Z.;Gadzinska J.;Mandziuk J.;Okarska-Napierala M.;Alacheva Z. A.;Alexeeva E.;Ananin P. V.;Antsupova M.;Bakradze M. D.;Bobkova P.;Borzakova S.;Chashchina I. L.;Fisenko A. P.;Gautier M. S.;Glazyrina A.;Kondrikova E.;Korobyants E.;Korsunskiy A. A.;Kovygina K.;Krasnaya E.;Kurbanova S.;Kurdup M. K.;Mamutova A. V.;Mazankova L.;Mitushin I. L.;Nargizyan A.;Orlova Y. O.;Osmanov I. M.;Polyakova A. S.;Romanova O.;Samitova E.;Sologub A.;Spiridonova E.;Tepaev R. F.;Tkacheva A. A.;Yusupova V.;Zholobova E.;Grasa C. D.;Segura N. L.;Martinon-Torres F.;Melendo S.;Echevarria A. M.;Guzman J. M. M.;Argueta J. R. P.;Rivero-Calle I.;Riviere J.;Rodriguez-Gonzalez M.;Rojo P.;Manubens J. S.;Soler-Palacin P.;Soriano-Arandes A.;Tagarro A.;Villaverde S.;Altman M.;Brodin P.;Horne A.;Palmblad K.;Brotschi B.;Sauteur P. M.;Schmid J. P.;Prader S.;Relly C.;Schlapbach L. J.;Seiler M.;Truck J.;Wutz D.;Ketharanathan N.;Vermont C.;Ozkan E. A.;Erdeniz E. H.;Borisova G.;Boychenko L.;Diudenko N.;Kasiyan O.;Katerynych K.;Melnyk K.;Miagka N.;Teslenko M.;Trykosh M.;Volokha A.;Akomolafe T.;Al-Abadi E.;Alders N.;Avram P.;Bamford A.;Bank M.;Roy R. B.;Beattie T.;Boleti O.;Broad J.;Carrol E. D.;Chandran A.;Cooper H.;Davies P.;Emonts M.;Evans C.;Fidler K.;Foster C.;Gong C.;Gongrun B.;Gonzalez C.;Grandjean L.;Grant K.;Hacohen Y.;Hall J.;Hassell J.;Hesketh C.;Hewlett J.;Hnieno A.;Holt-Davis H.;Hossain A.;Hudson L. D.;Johnson M.;Johnson S.;Jyothish D.;Kampmann B.;Kavirayani A.;Kelly D.;Kucera F.;Langer D.;Lillie J.;Longbottom K.;Lyall H.;MacKdermott N.;Maltby S.;McLelland T.;McMahon A. -M.;Miller D.;Morrison Z.;Mosha K.;Muller J.;Myttaraki E.;Nadel S.;Osaghae D.;Osman F.;Ostrzewska A.;Panthula M.;Papachatzi E.;Papadopoulou C.;Penner J.;Polandi S.;Prendergast A. J.;Ramnarayan P.;Rhys-Evans S.;Riordan A.;Rodrigues C. M. C.;Romaine S.;Seddon J.;Shingadia D.;Srivastava A.;Struik S.;Taylor A.;Taylor A.;Taylor A.;Tran S.;Tudor-Williams G.;Van Der Velden F.;Ventilacion L.;Wellman P. A.;Yanney M. P.;Yeung S.;Badheka A.;Badran S.;Bailey D. M.;Burch A. K.;Burns J. C.;Cichon C.;Cirks B.;Dallman M. D.;Delany D. R.;Fairchok M.;Friedman S.;Geracht J.;Langs-Barlow A.;Mann K.;Padhye A.;Quade A.;Ramirez K. A.;Rockett J.;Sayed I. A.;Shahin A. A.;Umaru S.;Widener R.;Angela M. H.;Kandawasvika G.
2021
Abstract
BACKGROUND Evidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. METHODS We performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation. RESULTS Data were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups. CONCLUSIONS We found no evidence that recovery from MIS-C differed after primary treatment with IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone, although significant differences may emerge as more data accrue.
McArdle A.J., Vito O., Patel H., Seaby E.G., Shah P., Wilson C., et al. (2021). Treatment of Multisystem Inflammatory Syndrome in Children. THE NEW ENGLAND JOURNAL OF MEDICINE, 385(1), 11-22 [10.1056/NEJMoa2102968].
McArdle A.J.; Vito O.; Patel H.; Seaby E.G.; Shah P.; Wilson C.; Broderick C.; Nijman R.; Tremoulet A.H.; Munblit D.; Ulloa-Gutierrez R.; Carter M.J.;...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/853264
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.