Table 3.

Possible doses for immunomodulatory agents in the treatment of MIS-C, depending on phenotypic characteristics.

Medication Class	Dose	Important Notes
IVIG [16,34]	If they meet KD criteria: 2 g/kg IV typically given in a single dose If they meet SHLH criteria: 1–2 g/kg IV	Use with caution if fluid overload, renal dysfunction. Consider alternate dosing strategy.
Aspirin	If they meet KD criteria: 30–50 mg/kg/d, decrease to 3–5 mg/kg/d once afebrile × 48 h	Precaution in severe thrombocytopenia
Corticosteroids [34,39]	For severe KD *: ○Dosing strategy 1: Methylprednisone 0.8 mg/kg BID IV for 5–7 d or until CRP normalizes followed by PO prednisone/prednisolone 2 mg/kg/d with wean over 2–3 w ○Dosing strategy 2: Methylprednisolone 10–30 mg/kg IV QD for 3 d followed by PO prednisone/prednisolone 2 mg/kg/d until d 7 or until CRP normalizes and then wean over 2–3 w  For SHLH ** ○Methylprednisone pulsed dosing of 30 mg/kg IV QD × 3 doses followed by 1 mg/kg IV q12 h, wean to be determined by peds rheumatology, immunology, or H/O	Precaution if positive RT-PCR for SARS-CoV-2, suggesting active infection
Anakinra [16,34]	2–6 mg/kg/day IV/SQ, length of therapy to be decided with input from pediatric rheumatology or immunology
Tocilizumab	<30 Kg: 12 mg/kg IV >30 Kg: 8 mg/kg IV	Trials ongoing for safety and efficacy in the setting of active coronavirus infection [40]

Abbreviations: BID, twice daily; d, days; g, gram; h, hours; H/O, hematology–oncology; IV, intravenous; IG, immune globulin; KD, Kawasaki disease; kg, kilograms; mg, milligrams; PO, by mouth; q, every; QD, every day; RT-PCR, reverse transcriptase PCR; SHLH, secondary hemophagocytic lymphohistiocytosis; SQ, subcutaneous; w, weeks. *—see text for definition. **—per clinical discretion.