The clinical efficacy of biological immunomodulators in SARS-CoV-2-
associated multisystem inflammatory syndrome in children: A systematic
review
Abstract
The clinical efficacy of biological immunomodulators in patients
refractory to standard therapy of intravenous immunoglobulin (IVIg) and
glucocorticoids remains unclear. This review aimed to outline real-world
data on the clinical outcomes of biological immunomodulators using
Ovid-Medline, EMBASE, Cochrane CDSR, and the Korean database, KMBASE
from September 2021 to August 2022. Among 251 studies , 10 were
selected, of which two were observational studies with control groups
receiving a standard therapy of IVIg and/or glucocorticoids. In total,
145 patients were treated with biological agents. In the first study
with a control group, anakinra-treated group exhibited a lower left
ventricular ejection fraction at baseline (54% vs. 60%, P =
0.08). Patients in the infliximab group of second study showed lesser
additional treatment requirements (31% vs. 65%, P = 0.01), and
lower rate of newly developed left ventricular dysfunction (4% vs.
20%, P = 0.05). The remaining eight single-arm studies did not
report the clinical outcomes of each type of biological immunomodulator
individually, limiting further interpretation. The findings of this
review imply the potential of biological immunomodulators as a feasible
therapeutic option for refractory MIS-C.