Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study
Abstract Background and objective Evidence for the treatment of multisystem inflammatory syndrome in children (MIS-C) is lacking. Anakinra, which targets IL-1-mediated inflammation, is reserved for refractory cases of MIS-C; however, its use in the treatment of MIS-C is not clearly established. Pati...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Pediatric Rheumatology Online Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12969-023-00858-z |
| _version_ | 1797752842036969472 |
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| author | Brian L.P. Dizon Christopher Redmond Emily C. Gotschlich Sangeeta Sule Tova Ronis Kathleen M. Vazzana Matthew A. Sherman Rachael Connor Abigail Bosk Niti Dham Ashraf S. Harahsheh Elizabeth Wells Roberta DeBiasi Hemalatha Srinivasalu |
| author_facet | Brian L.P. Dizon Christopher Redmond Emily C. Gotschlich Sangeeta Sule Tova Ronis Kathleen M. Vazzana Matthew A. Sherman Rachael Connor Abigail Bosk Niti Dham Ashraf S. Harahsheh Elizabeth Wells Roberta DeBiasi Hemalatha Srinivasalu |
| author_sort | Brian L.P. Dizon |
| collection | DOAJ |
| description | Abstract Background and objective Evidence for the treatment of multisystem inflammatory syndrome in children (MIS-C) is lacking. Anakinra, which targets IL-1-mediated inflammation, is reserved for refractory cases of MIS-C; however, its use in the treatment of MIS-C is not clearly established. Patients and methods To examine a role for anakinra in MIS-C, we performed a single center observational cohort study of all MIS-C patients diagnosed at our children’s hospital from May 15 to November 15, 2020. Demographics, clinical features, diagnostic testing, and cardiac function parameters were compared between MIS-C patients treated with intravenous immunoglobulin (IVIG) monotherapy and IVIG with anakinra (IVIG + anakinra). Results Among 46 patients with confirmed MIS-C, 32 (70%) were in the IVIG + anakinra group, of which 9 (28%) were also given corticosteroids (CS). No patients were treated with anakinra alone. MIS-C patients in the IVIG + anakinra group were enriched in a CV shock phenotype (p = 0.02), and those with CV shock were treated with higher doses of anakinra for a longer duration. Furthermore, MIS-C patients in the IVIG + anakinra group exhibited improvements in fever and cardiac function with or without CS. No significant adverse events were observed, and no differences in IL-1β levels were found among MIS-C patients in the IVIG + anakinra group. Conclusions Anakinra treatment, which was co-administered with IVIG primarily in patients with severe MIS-C, was associated with improvements in fever and cardiac function, and demonstrated a favorable side-effect profile. These findings suggest a role for adjunctive anakinra in the treatment of severe MIS-C. |
| first_indexed | 2024-03-12T17:09:18Z |
| format | Article |
| id | doaj.art-7386f54425b0427ea9b159ff216ba405 |
| institution | Directory Open Access Journal |
| issn | 1546-0096 |
| language | English |
| last_indexed | 2024-03-12T17:09:18Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj.art-7386f54425b0427ea9b159ff216ba4052023-08-06T11:09:27ZengBMCPediatric Rheumatology Online Journal1546-00962023-07-012111810.1186/s12969-023-00858-zClinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational studyBrian L.P. Dizon0Christopher Redmond1Emily C. Gotschlich2Sangeeta Sule3Tova Ronis4Kathleen M. Vazzana5Matthew A. Sherman6Rachael Connor7Abigail Bosk8Niti Dham9Ashraf S. Harahsheh10Elizabeth Wells11Roberta DeBiasi12Hemalatha Srinivasalu13Division of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDivision of Rheumatology, Children’s National HospitalDepartment of Pediatrics, George Washington University School of Medicine & Health SciencesDepartment of Pediatrics, George Washington University School of Medicine & Health SciencesDepartment of Pediatrics, George Washington University School of Medicine & Health SciencesDepartment of Pediatrics, George Washington University School of Medicine & Health SciencesDivision of Rheumatology, Children’s National HospitalAbstract Background and objective Evidence for the treatment of multisystem inflammatory syndrome in children (MIS-C) is lacking. Anakinra, which targets IL-1-mediated inflammation, is reserved for refractory cases of MIS-C; however, its use in the treatment of MIS-C is not clearly established. Patients and methods To examine a role for anakinra in MIS-C, we performed a single center observational cohort study of all MIS-C patients diagnosed at our children’s hospital from May 15 to November 15, 2020. Demographics, clinical features, diagnostic testing, and cardiac function parameters were compared between MIS-C patients treated with intravenous immunoglobulin (IVIG) monotherapy and IVIG with anakinra (IVIG + anakinra). Results Among 46 patients with confirmed MIS-C, 32 (70%) were in the IVIG + anakinra group, of which 9 (28%) were also given corticosteroids (CS). No patients were treated with anakinra alone. MIS-C patients in the IVIG + anakinra group were enriched in a CV shock phenotype (p = 0.02), and those with CV shock were treated with higher doses of anakinra for a longer duration. Furthermore, MIS-C patients in the IVIG + anakinra group exhibited improvements in fever and cardiac function with or without CS. No significant adverse events were observed, and no differences in IL-1β levels were found among MIS-C patients in the IVIG + anakinra group. Conclusions Anakinra treatment, which was co-administered with IVIG primarily in patients with severe MIS-C, was associated with improvements in fever and cardiac function, and demonstrated a favorable side-effect profile. These findings suggest a role for adjunctive anakinra in the treatment of severe MIS-C.https://doi.org/10.1186/s12969-023-00858-zMultisystem inflammatory syndrome in childrenCardiac dysfunctionSARS-CoV2AnakinraTherapy |
| spellingShingle | Brian L.P. Dizon Christopher Redmond Emily C. Gotschlich Sangeeta Sule Tova Ronis Kathleen M. Vazzana Matthew A. Sherman Rachael Connor Abigail Bosk Niti Dham Ashraf S. Harahsheh Elizabeth Wells Roberta DeBiasi Hemalatha Srinivasalu Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study Pediatric Rheumatology Online Journal Multisystem inflammatory syndrome in children Cardiac dysfunction SARS-CoV2 Anakinra Therapy |
| title | Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study |
| title_full | Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study |
| title_fullStr | Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study |
| title_full_unstemmed | Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study |
| title_short | Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study |
| title_sort | clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children a single center observational study |
| topic | Multisystem inflammatory syndrome in children Cardiac dysfunction SARS-CoV2 Anakinra Therapy |
| url | https://doi.org/10.1186/s12969-023-00858-z |
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