Abstract
The purpose of this systematic review is to evaluate the efficacy and safety of using potential drugs: remdesivir and glucocorticoid in treating children and adolescents with COVID-19 and intravenous immunoglobulin (IVIG) in treating MIS-C. We searched seven databases, three preprint platform, ClinicalTrials.gov, and Google from December 1, 2019, to August 5, 2021, to collect evidence of remdesivir, glucocorticoid, and IVIG which were used in children and adolescents with COVID-19 or MIS-C. A total of nine cohort studies and one case series study were included in this systematic review. In terms of remdesivir, the meta-analysis of single-arm cohort studies have shown that after the treatment, 54.7% (95%CI, 10.3 to 99.1%) experienced adverse events, 5.6% (95%CI, 1.2 to 10.1%) died, and 27.0% (95%CI, 0 to 73.0%) needed extracorporeal membrane oxygenation or invasive mechanical ventilation. As for glucocorticoids, the results of the meta-analysis showed that the fixed-effect summary odds ratio for the association with mortality was 2.79 (95%CI, 0.13 to 60.87), and the mechanical ventilation rate was 3.12 (95%CI, 0.80 to 12.08) for glucocorticoids compared with the control group. In terms of IVIG, most of the included cohort studies showed that for MIS-C patients with more severe clinical symptoms, IVIG combined with methylprednisolone could achieve better clinical efficacy than IVIG alone.Conclusions: Overall, the current evidence in the included studies is insignificant and of low quality. It is recommended to conduct high-quality randomized controlled trials of remdesivir, glucocorticoids, and IVIG in children and adolescents with COVID-19 or MIS-C to provide substantial evidence for the development of guidelines.What is Known:• The efficacy and safety of using potential drugs such as remdesivir, glucocorticoid, and intravenous immunoglobulin (IVIG) in treating children and adolescents with COVID-19/MIS-C are unclear.What is New:• Overall, the current evidence cannot adequately demonstrate the effectiveness and safety of using remdesivir, glucocorticoids, and IVIG in treating children and adolescents with COVID-19 or MIS-C.• We are calling for the publication of high-quality clinical trials and provide substantial evidence for the development of guidelines.
Highlights
It is over a year and a half since the outbreak of coronavirus disease 2019 (COVID-19), and during this period, studies on COVID-19 are continuously emerging [1, 2]
We are calling for the publication of high-quality clinical trials and provide substantial evidence for the development of guidelines
Group 1 focused on remdesivir in treating children and adolescents with COVID-19, Group 2 focused on glucocorticoids in treating children and adolescents with severe COVID-19, and Group 3 focused on intravenous immunoglobulin (IVIG) in treating children and adolescents with MIS-C
Summary
It is over a year and a half since the outbreak of coronavirus disease 2019 (COVID-19), and during this period, studies on COVID-19 are continuously emerging [1, 2]. Researchers have paid much attention to drug therapy all the time [3]. Recent studies on COVID-19 drugs and clinical guidelines have focused primarily on adult patients but less attention on children and adolescents. Children and adolescents with COVID-19 seem less susceptible and have milder symptoms once infected, they are at risks of advancing to severe stages [4]. Children and adults are known to have physiological differences [5]; many effective COVID19 drugs for adults may not suitable for children. Among these drugs, remdesivir, glucocorticoids, and intravenous immunoglobulin (IVIG) in children and adolescents have been controversial
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