MIS-C Treatment Outcomes

[SurfingDoctor]

Not that anyone really frequents this forum BUT....


So one with a positive effect and one without. To me, that means it's a wash. I mean, I think we should stop pretending that we understand anything about systemic inflammation. At this point it's all conjecture and some pseudo-science that has gotten us nowhere fast.

I also think it's incredibly disheartening that despite a very homogeneous population with a very specific trigger, the idea of immunomodulating acute systemic disease is mostly a beside what was already the standard of care. That doesn't bode well for any other acute, acquired systemic disease we try to treat.

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[Rumalum]

Patients are started on treatment after the damage has already been done. Observational studies are noise and meaningless. Better question is why are vaccine trials still staggered adults --> >12 --> >8, etc?

 

[SurfingDoctor]

Patients are started on treatment after the damage has already been done. Observational studies are noise and meaningless. Better question is why are vaccine trials still staggered adults --> >12 --> >8, etc?

That's a fair question. I think initially, there was a concern that in the 12-18 year old range, theoretically, the antibodies generated by the vaccination could cause MIS-C like syndromes, since that disease is antibody mediated. However, the "data" is that MIS-C is rare, and the outcomes are so good, its relatively meaningless. So that hypothesis is not so much wrong as it just doesn't matter.

I think a better question is that COVID doesn't really effect children. Like at all. All the patients I've seen hospitalized are hospitalized for a different reason and COVID is an incidental finding. That is unlike flu which very much causes hospitalizations in children with significant morbidity and mortality. I guess the bigger question is should there be large efforts to vaccinate a population that is essentially immune to the disease. That's a tough one to answer. That being said, it probably should just to open to whoever at this juncture, since I think the most susceptible populations have already had the opportunity to get it if they desire.

And yes... these observational studies are essentially garbage.

 

[BigRedBeta]

Can never manage to get my saved drafts to show up later...

Anyways, had another response typed out but it's gone in the ether.

I think both are ultimately underpowered to see the actual clinical effect, especially with so many treatment groups to parse out. Years from now we'll get the meta-analysis with the 10k+ patients actually needed.

Based on this paper (JCI - Multisystem inflammatory syndrome in children is driven by zonulin-dependent loss of gut mucosal barrier) and the idea of a superantigen continuing to trigger T-cells non-specifically perhaps there's better options out there that would be worth a compassionate use trial.

 

[SurfingDoctor]

Can never manage to get my saved drafts to show up later...

Anyways, had another response typed out but it's gone in the ether.

I think both are ultimately underpowered to see the actual clinical effect, especially with so many treatment groups to parse out. Years from now we'll get the meta-analysis with the 10k+ patients actually needed.

Based on this paper (JCI - Multisystem inflammatory syndrome in children is driven by zonulin-dependent loss of gut mucosal barrier) and the idea of a superantigen continuing to trigger T-cells non-specifically perhaps there's better options out there that would be worth a compassionate use trial.

I guess I'm more annoyed (maybe that's not the right word), that during the whole COVID pandemic thing, I feel like generally nothing new was learned. I didn't treat adults with COVID ARDS except for two that landed in the unit but it was like ventilation and steroids and then some anti-viral which kills SARS in a petri dish (which was essentially the H1N1 pandemic in a nutshell). We did see a fair share of MIS-C for which we applied the same therapies as we did for viral/post-viral myocarditis 2 decades ago (and for which those papers linked above don't test the efficacy so much as they confirm we still provide the same treatments, albeit haphazardly). I mean, for the amount of papers and "research" done during COVID and the money spent, you'd think we would have learned something beyond wearing masks and getting vaccinated is good, but apparently not.

I mean, you're probably right in that there is probably something more unique and targetable (though I find the concept that biomarkers leading to that discover to be highly questionable), but reality has shown, we can't identify it in real time to make a meaningful impact and instead waste dollars testing the standard of care and reinventing the wheel because that is the lower hanging fruit. I will give the authors of the article you linked for at least trying something different. Critical care medicine is full of such inertia in that regard and instead testing the same hypotheses over and over again till we realize the futility of it all (or not... looking at you Hydrocortisone).

I guess we can all be fortunate that this virus really didn't impact children cause if it did, I'm not convinced our ability to budge the needle on outcomes. I find that a little frustrating (and kinda humbling from a research standpoint).

As a side note, ether was an incredible discovery for modern medicine, but that's a digression.

 

[Stitch]

I can't say I'm surprised. As you all have observed there's a lot of things we do, but ultimately there's very little that actually treats viral illnesses. We are in our infancy when it comes to viral infections, almost like the pre antibiotic era with the exception of HIV and hepatitis. Hopefully some day that will change. Until then good supportive care is all we have.

This should also illustrate why vaccines are so important in general. Preventative care is essential.

 

[BigRedBeta]

I guess I'm more annoyed (maybe that's not the right word), that during the whole COVID pandemic thing, I feel like generally nothing new was learned. I didn't treat adults with COVID ARDS except for two that landed in the unit but it was like ventilation and steroids and then some anti-viral which kills SARS in a petri dish (which was essentially the H1N1 pandemic in a nutshell). We did see a fair share of MIS-C for which we applied the same therapies as we did for viral/post-viral myocarditis 2 decades ago (and for which those papers linked above don't test the efficacy so much as they confirm we still provide the same treatments, albeit haphazardly). I mean, for the amount of papers and "research" done during COVID and the money spent, you'd think we would have learned something beyond wearing masks and getting vaccinated is good, but apparently not.

I mean, you're probably right in that there is probably something more unique and targetable (though I find the concept that biomarkers leading to that discover to be highly questionable), but reality has shown, we can't identify it in real time to make a meaningful impact and instead waste dollars testing the standard of care and reinventing the wheel because that is the lower hanging fruit. I will give the authors of the article you linked for at least trying something different. Critical care medicine is full of such inertia in that regard and instead testing the same hypotheses over and over again till we realize the futility of it all (or not... looking at you Hydrocortisone).

I guess we can all be fortunate that this virus really didn't impact children cause if it did, I'm not convinced our ability to budge the needle on outcomes. I find that a little frustrating (and kinda humbling from a research standpoint).

As a side note, ether was an incredible discovery for modern medicine, but that's a digression.

We definitely aren't as smart as we'd like to think we are.