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Table 3d. Therapeutic Management of Hospitalized Pediatric Patients With MIS-C

Last Updated: February 24, 2022

Table 3d. Therapeutic Management of Hospitalized Pediatric Patients With MIS-C
Patient ConditionPanel’s Recommendations
MIS-CInitial treatment for MIS-C includes both immunomodulatory and antithrombotic therapy.
Initial Immunomodulatory Therapy:
  • IVIG 2 g/kg IBW/dose (up to a maximum total dose of 100 g)a IV plus low-to-moderate dose methylprednisolone (1–2 mg/kg/day) IVa or another glucocorticoid at an equivalent dosea (AIIb).
  • The Panel recommends against the routine use of IVIG monotherapy for the treatment of MIS-C unless glucocorticoid use is contraindicated (AIIb).
Intensification Immunomodulatory Therapy:
  • For children with refractory MIS-C who do not improve within 24 hours of initial immunomodulatory therapy, start one of the following (listed in alphabetical order) (AIII):
    • High-dose anakinra 5–10 mg/kg IV or SUBQ daily (BIIb), or
    • Higher-dose glucocorticoid (e.g., methylprednisolone 10–30 mg/kg/day IV or equivalent glucocorticoid) (BIIb),b or
    • Infliximabc 5–10 mg/kg IV for 1 dose (BIIb).
Antithrombotic Treatment:
  • Low-dose aspirin (3–5 mg/kg/day, up to maximum daily dose of 81 mg) PO for all patients without risk factors for bleeding (AIII), AND
  • Anticoagulation for patients who fall under 1 of the following clinical scenarios:
    • Therapeutic anticoagulation for patients with large CAAs according to the American Heart Association guidelines for Kawasaki disease (AIII).
    • Therapeutic anticoagulation for patients with moderate to severe LV dysfunction who have no risk factors for bleeding (AIII).
    • For patients with MIS-C who do not have large CAAs or moderate to severe LV dysfunction, consider prophylactic or therapeutic anticoagulation on an individual basis, taking into consideration risk factors for thrombosis. See Table 3e for additional information.
Rating of Recommendations: A = Strong; B = Moderate; C = Weak
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion