CMAAO Coronavirus Facts and Myth Buster: Mucocutaneous manifestations of MIS-C; Baricitinib plus remdesivir

5:18 am Health Care

With input from Dr Monica Vasudev

1210: DG Alerts: Mucocutaneous manifestations of multisystem inflammatory syndrome in children: An array of mucocutaneous findings was identified in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or suspected MIS-C during the COVID-19 pandemic, reported a case series published in JAMA Dermatology.

Of the patients assessed, 83% developed mucocutaneous changes, with the most common being conjunctival injection, palmoplantar erythema, lip hyperemia, periorbital erythema and edema, strawberry tongue, and malar erythema. Other cutaneous morphologic findings included scarlatiniform eruptions, morbilliform eruptions, urticarial eruptions, and reticulated eruptions. Among those with mucocutaneous changes, 19 patients experienced fever a mean of 2.7 days (range, 1-7 days) prior to the recognition of the first mucocutaneous finding. The duration of mucocutaneous findings ranged from hours to days (median duration, 5 days [range, 0-11 days]).

Overall, 19 patients had cardiac involvement as noted by elevated troponin and/or brain natriuretic peptide levels, while 10 had abnormal echocardiogram findings; five patients with cardiac involvement needed inotropic support. Ten patients were admitted to the intensive care unit (ICU). There appeared to be no statistically significant associations between the presence of mucocutaneous findings and cardiac dysfunction, need for inotropic support, or ICU admission, which suggests that mucocutaneous changes were not tied to disease severity in MIS-C.

Conjunctivitis, lip hyperemia or cracking, and palmoplantar erythema exhibited an even distribution across all ages; however, urticarial eruptions were noted in those below 2 years of age, and periorbital and palmoplantar edema were evident in those younger than 6 years.

[SOURCE: JAMA Dermatology]

1211:  Baricitinib plus remdesivir shows promise in treatment of COVID-19:  The combination of baricitinib, an anti-inflammatory drug, and remdesivir, an antiviral, was found to reduce the time to recovery among hospitalized COVID-19 patients, suggested clinical trial results published in the New England Journal of Medicine. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The ACTT-2 trial started on May 8, 2020 and recruited 1,033 volunteers at sites in eight countries. Participants were randomized to receive either oral baricitinib tablets and intravenous (IV) remdesivir or oral placebo tablets and IV remdesivir.

Combination of baricitinib and remdesivir reduced median time to recovery among hospitalized COVID-19 patients from 8 days to 7 days. Patients requiring high-flow oxygen or non-invasive ventilation during hospitalization were shown to obtain the largest benefit. The median time to recovery in these patients was reduced from 18 days to 10 days. Furthermore, participants’ condition at day 15 (measured by an eight-category ordinal scale which ranked the severity of their condition) was significantly improved when they received the combination therapy. Those who were given the two treatments also had slightly fewer serious adverse effects.

[Source: NIH]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Comments are closed.