Table 4.

Therapeutic options for MIS-C in children.^65,71

	Mild disease	Moderate-severe diseasea
Steroids	Methylprednisolone 2 mg/kg/day IV divided q12h (max 60 mg/day) for the first 5 days, then transitioned to oral prednisone and tapered over 2 weeks	Methylprednisolone 10–20 mg/kg/day IV divided q12h on the first day (max 500 mg/day), followed by 2 mg/kg/day IV divided q12h (max 60 mg/day) for days 2–5, then transitioned to oral prednisone and tapered over 3–6 weeksb
IVIG	Only if patient meets the criteria for Kawasaki disease (including incomplete definition as per AHA72) or has coronary artery dilation or aneurysm	Yes: 2 g/kg—based on ideal body weight—can be divided into two doses if concerns about LV dysfunctionc
Anakinra	No	For severe or refractory cases consider 2–10 mg/kg/day IV or SQ for a minimum of 5 days (or longer depending on the clinical response)d
Anti-platelet therapy and anticoagulation	Low-dose aspirin	Prophylactic enoxaparin. Aspirin may be added per cardiology discretion
GI protection (i.e., H2 blocker)	Yes	Yes

^aModerate-severe disease defined as: need for vasoactive medications or inotropes, mechanical ventilation, significantly decreased LV function, ICU admission.

^bRECOVERY trial (recoverytrial.net)⁷³ used methylprednisolone sodium succinate 10 mg/kg (as base; maximum, 1 g) once daily for 3 days.

^cRECOVERY trial (recoverytrial.net)⁷³ used 2 g/kg as a single dose (based on ideal body weight in line with NHS England guidance) for children with corrected gestational age >44 weeks and <18 years with PIMS-TS phenotype.

^dRECOVERY trial (recoverytrial.net)⁷³ used 2 mg/kg daily for 7 days or until discharge whichever is sooner for children with PIMS-TS (>12 months of age and >10 kg body weight).