Table 3.

Anti-inflammatory therapies in patients with PIMS-TS.

Class	Drug	Route	Dose	Duration	Comments and side effects
Blood products	IVIG	IV	2 g/kg (max 100 g)	Infusion over 12 h	Side effects: Aseptic meningitis, volume load, systemic inflammation, hemolytic anemia, neutropenia. Slower the rate or divide the dose over 2 days if signs of volume overload or severe cardiac dysfunction
Corticosteroids	Methylprednisolone	IV	2 mg/kg daily (max 60 mg/day) or 10 mg/kg daily for 1–3 days (max 1 g/day)	1–3 days discuss in MDT	Side effects: Hyperglycemia, hypertension, agitation Note: dose increase up to 30 mg/kg can be considered if refractory
	Prednisolone	PO	1 mg/kg q12 h or 2 mg/kg q24 h (max 60 mg/day)	Up to 2–6 weeks	Taper: over 2–6 weeks
Biologicals	Anakinra (recombinant interleukin-1 receptor antagonist)	SC	start at 2–3 mg/kg q12 h (max. 100 mg/dose)	Discuss in MDT	Escalation/taper: MDT decision. IV administration possible under different dosing scheme. Side effects: neutropenia, leukopenia, thrombocytopenia, eosinophilia, headache, abdominal pain, nausea/vomiting, diarrhea, hepatitis, increased serum transaminases, hypersensitivity reactions, injection-site reactions, skin rash, arthralgia
	Tocilizumab (recombinant interleukin-6 receptor)	IV	<30 kg: 12 mg/kg single dose (max 800 mg) ≥30 kg: 8 mg/kg single dose (max 800 mg)	Discuss in MDT	Escalation: If no clinical improvement after initial dose, may repeat dose 8–12 h after the initial dose after MDT discussion. Side effects: neutropenia, leukopenia, thrombocytopenia, anemia, pain, headache, dizziness, insomnia, demyelinating disorders, ulcerations, nausea, increased serum transaminases, liver impairment, increase in serum lipids, pancreatitis, hypertension, hypothyroidism, hypersensitivity reactions, Steven-Johnson-Syndrome, conjunctivitis, nephrolithiasis, injection-site reactions, rash
	Infliximab (chimeric tumor necrosis factor TNF α monoclonal antibody)	IV	5 mg/kg single dose	Discuss in MDT	Side effects: neutropenia, leukopenia/agranulocytosis, thrombocytopenia, anemia, pain, headache, dizziness, insomnia, demyelinating disorders, hypersensitivity reactions, injection-site reactions, skin rash

Data were accessed from www.accessdata.fda.gov/, www.ema.europa.eu/, and the British Pediatric Allergy, Immunity, and Infection Group [Position Statement: Management of novel coronavirus (SARS-CoV-2) infection in pediatric patients in the UK and Ireland] and adapted from the Imperial College Healthcare NHS Trust PIMS-TS guideline for external use. MDT, multidisciplinary team; IVIG, intravenous immunoglobulins.

Disclaimer: Medication dosing and administration should be checked with the local hospital pharmacists and considering recent evidence updates. Where possible, PIMS-TS patients should be enrolled in interventional studies.