Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study
BackgroundThe treatment of multisystem inflammatory syndrome in children unresponsive to first-line therapies (IVIG and/or steroids) is challenging. The effectiveness of IL-1 receptor antagonist, anakinra, is debated.Patients and methodsWe conducted an anonymous retrospective multicenter study on MI...
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| Format: | Article |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1137051/full |
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| author | Francesco Licciardi Carlotta Covizzi Marta Dellepiane Nicole Olivini Maria Vincenza Mastrolia Andrea Lo Vecchio Viviana Monno Maria Tardi Angela Mauro Maria Alessio Giovanni Filocamo Marco Cattalini Andrea Taddio Roberta Caorsi Gian Luigi Marseglia Francesco La Torre Andrea Campana Gabriele Simonini Angelo Ravelli Davide Montin |
| author_facet | Francesco Licciardi Carlotta Covizzi Marta Dellepiane Nicole Olivini Maria Vincenza Mastrolia Andrea Lo Vecchio Viviana Monno Maria Tardi Angela Mauro Maria Alessio Giovanni Filocamo Marco Cattalini Andrea Taddio Roberta Caorsi Gian Luigi Marseglia Francesco La Torre Andrea Campana Gabriele Simonini Angelo Ravelli Davide Montin |
| author_sort | Francesco Licciardi |
| collection | DOAJ |
| description | BackgroundThe treatment of multisystem inflammatory syndrome in children unresponsive to first-line therapies (IVIG and/or steroids) is challenging. The effectiveness of IL-1 receptor antagonist, anakinra, is debated.Patients and methodsWe conducted an anonymous retrospective multicenter study on MIS-C patients treated with anakinra in Italy from January 2020 to February 2021. Our study outcomes included the percentage of patients who required further therapeutic step-up, the percentage of patients who experienced fever resolution within 24 h and a reduction of CRP by half within 48 h, and the percentage of patients who developed Coronary Artery Anomalies (CAA) during follow-up.Results35 cases of MIS-C were treated in 10 hospitals. Of these, 13 patients started anakinra while in the ICU, and 22 patients started anakinra in other wards. 25 patients (71.4%) were treated with corticosteroids at a starting dose 2–30 mg/Kg/day plus IVIG (2 g/Kg), 10 patients (28.6%) received only corticosteroids without IVIG. Anakinra was administered intravenously to all patients in Group A (mean dose 8 mg/Kg/day), and subcutaneously in Group B (mean dose 4 mg/Kg/day). Only two patients required further treatment step-up and no patients developed CAA after receiving anakinra. The most commonly observed side effect was an increase in ALT, occurring in 17.1% of patients.ConclusionsIn this retrospective cohort of severe MIS-C patients treated with anakinra we report favorable clinical outcomes with a low incidence of side effects. The simultaneous use of steroids ± IVIG in these patients hinders definitive conclusions regarding the need of IL-1 inhibition in MIS-C treatment. |
| first_indexed | 2024-03-12T13:55:30Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-12T13:55:30Z |
| publishDate | 2023-08-01 |
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| series | Frontiers in Pediatrics |
| spelling | doaj.art-0ba1119c8ddc43f390653831e7309aa62023-08-22T15:59:42ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-08-011110.3389/fped.2023.11370511137051Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national studyFrancesco Licciardi0Carlotta Covizzi1Marta Dellepiane2Nicole Olivini3Maria Vincenza Mastrolia4Andrea Lo Vecchio5Viviana Monno6Maria Tardi7Angela Mauro8Maria Alessio9Giovanni Filocamo10Marco Cattalini11Andrea Taddio12Roberta Caorsi13Gian Luigi Marseglia14Francesco La Torre15Andrea Campana16Gabriele Simonini17Angelo Ravelli18Davide Montin19Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, ItalyDivision of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, ItalyDivision of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, ItalyPediatrics Unit, University Department of Pediatrics (DEAPG), Bambino Gesù Children’s Hospital—IRCCS, Rome, ItalyRheumatology Unit, Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, ItalySection of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyPediatric Rheumatology Section, Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Bari, ItalyRheumatology Unit, Department of Pediatrics, Santobono Pausilipon Children Hospital, Naples, ItalyCOVID Unit, Emergency Department, Santobono-Pausilipon Children Hospital, Naples, ItalySection of Paediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyPediatric Rheumatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, ItalySpedali Civili, Unità di Immunologia e Reumatologia Pediatrica, Clinica Pediatrica dell’Università di Brescia, Brescia, Italy0Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, Trieste and University of Trieste, Trieste, Italy1Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy2Pediatric Clinic Foundation IRCCS Policlinico S. Matteo, University of Pavia, Pavia, ItalyPediatric Rheumatology Section, Department of Pediatrics, Giovanni XXIII Pediatric Hospital, Bari, ItalyPediatrics Unit, University Department of Pediatrics (DEAPG), Bambino Gesù Children’s Hospital—IRCCS, Rome, ItalyRheumatology Unit, Department of Paediatrics, Meyer Children’s Hospital, University of Florence, Florence, Italy1Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, ItalyDivision of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, “Regina Margherita” Children Hospital, University of Turin, Turin, ItalyBackgroundThe treatment of multisystem inflammatory syndrome in children unresponsive to first-line therapies (IVIG and/or steroids) is challenging. The effectiveness of IL-1 receptor antagonist, anakinra, is debated.Patients and methodsWe conducted an anonymous retrospective multicenter study on MIS-C patients treated with anakinra in Italy from January 2020 to February 2021. Our study outcomes included the percentage of patients who required further therapeutic step-up, the percentage of patients who experienced fever resolution within 24 h and a reduction of CRP by half within 48 h, and the percentage of patients who developed Coronary Artery Anomalies (CAA) during follow-up.Results35 cases of MIS-C were treated in 10 hospitals. Of these, 13 patients started anakinra while in the ICU, and 22 patients started anakinra in other wards. 25 patients (71.4%) were treated with corticosteroids at a starting dose 2–30 mg/Kg/day plus IVIG (2 g/Kg), 10 patients (28.6%) received only corticosteroids without IVIG. Anakinra was administered intravenously to all patients in Group A (mean dose 8 mg/Kg/day), and subcutaneously in Group B (mean dose 4 mg/Kg/day). Only two patients required further treatment step-up and no patients developed CAA after receiving anakinra. The most commonly observed side effect was an increase in ALT, occurring in 17.1% of patients.ConclusionsIn this retrospective cohort of severe MIS-C patients treated with anakinra we report favorable clinical outcomes with a low incidence of side effects. The simultaneous use of steroids ± IVIG in these patients hinders definitive conclusions regarding the need of IL-1 inhibition in MIS-C treatment.https://www.frontiersin.org/articles/10.3389/fped.2023.1137051/fullMIS-Cmultisystem inflammatory syndromepediatricsCOVID-19SARS-CoV2 |
| spellingShingle | Francesco Licciardi Carlotta Covizzi Marta Dellepiane Nicole Olivini Maria Vincenza Mastrolia Andrea Lo Vecchio Viviana Monno Maria Tardi Angela Mauro Maria Alessio Giovanni Filocamo Marco Cattalini Andrea Taddio Roberta Caorsi Gian Luigi Marseglia Francesco La Torre Andrea Campana Gabriele Simonini Angelo Ravelli Davide Montin Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study Frontiers in Pediatrics MIS-C multisystem inflammatory syndrome pediatrics COVID-19 SARS-CoV2 |
| title | Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study |
| title_full | Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study |
| title_fullStr | Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study |
| title_full_unstemmed | Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study |
| title_short | Outcomes of MIS-C patients treated with anakinra: a retrospective multicenter national study |
| title_sort | outcomes of mis c patients treated with anakinra a retrospective multicenter national study |
| topic | MIS-C multisystem inflammatory syndrome pediatrics COVID-19 SARS-CoV2 |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1137051/full |
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