Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents
Abstract Background SARS-CoV-2 can induce an immune impairment and dysregulation, finally resulting in the massive release of inflammatory mediators (cytokine storm), strongly contributing to the pulmonary and systemic manifestations in severe coronavirus disease 2019 (COVID-19). As a consequence, d...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | Pediatric Rheumatology Online Journal |
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| Online Access: | https://doi.org/10.1186/s12969-021-00559-5 |
| _version_ | 1818600826866761728 |
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| author | Giorgio Costagliola Erika Spada Rita Consolini |
| author_facet | Giorgio Costagliola Erika Spada Rita Consolini |
| author_sort | Giorgio Costagliola |
| collection | DOAJ |
| description | Abstract Background SARS-CoV-2 can induce an immune impairment and dysregulation, finally resulting in the massive release of inflammatory mediators (cytokine storm), strongly contributing to the pulmonary and systemic manifestations in severe coronavirus disease 2019 (COVID-19). As a consequence, different drugs active on the immune system have been proposed for the treatment of the disease in adults. Role of the anti-rheumatic agents in children Children are more likely to develop a mild disease course, as the severe form of COVID-19 is identified in less than 5% of the pediatric patients. Moreover, in children a peculiar disease phenotype, defined as multisystem inflammatory syndrome in children (MIS-C) is observed, representing the most severe expression of the inflammatory dysregulation caused by SARS-CoV-2. The limited experience with the severe pediatric COVID-19 and MIS-C does not allow conclusions about the role of the immune pharmacological approach, and therefore the treatment of these conditions represents a considerable clinical challenge. The use of chloroquine, hydroxychloroquine, and colchicine in the early disease stages is not sufficiently supported by evidence, and there is an increasing interest in the role of biologic agents, including anti-IL-1 and anti-IL-6 agents, in the prevention and treatment of the severe manifestations of COVID-19. Conclusion The therapeutic approach to pediatric COVID-19 is multidisciplinary, and anti-rheumatic agents have a prominent role in severe disease. This paper reviews the rationale for the use of anti-rheumatic agents in pediatric COVID-19 and MIS-C and the clinical experience with the single drugs. Finally, the areas of potential improvement in the use of anti-rheumatic agents, including the optimization of the drug choice and the timing of administration, are discussed. |
| first_indexed | 2024-12-16T12:41:40Z |
| format | Article |
| id | doaj.art-bc944c2d7521483eb27cc7d511fb4ae3 |
| institution | Directory Open Access Journal |
| issn | 1546-0096 |
| language | English |
| last_indexed | 2024-12-16T12:41:40Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj.art-bc944c2d7521483eb27cc7d511fb4ae32022-12-21T22:31:25ZengBMCPediatric Rheumatology Online Journal1546-00962021-05-0119111110.1186/s12969-021-00559-5Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agentsGiorgio Costagliola0Erika Spada1Rita Consolini2Section of Rheumatology and Clinical Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of PisaSection of Rheumatology and Clinical Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of PisaSection of Rheumatology and Clinical Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of PisaAbstract Background SARS-CoV-2 can induce an immune impairment and dysregulation, finally resulting in the massive release of inflammatory mediators (cytokine storm), strongly contributing to the pulmonary and systemic manifestations in severe coronavirus disease 2019 (COVID-19). As a consequence, different drugs active on the immune system have been proposed for the treatment of the disease in adults. Role of the anti-rheumatic agents in children Children are more likely to develop a mild disease course, as the severe form of COVID-19 is identified in less than 5% of the pediatric patients. Moreover, in children a peculiar disease phenotype, defined as multisystem inflammatory syndrome in children (MIS-C) is observed, representing the most severe expression of the inflammatory dysregulation caused by SARS-CoV-2. The limited experience with the severe pediatric COVID-19 and MIS-C does not allow conclusions about the role of the immune pharmacological approach, and therefore the treatment of these conditions represents a considerable clinical challenge. The use of chloroquine, hydroxychloroquine, and colchicine in the early disease stages is not sufficiently supported by evidence, and there is an increasing interest in the role of biologic agents, including anti-IL-1 and anti-IL-6 agents, in the prevention and treatment of the severe manifestations of COVID-19. Conclusion The therapeutic approach to pediatric COVID-19 is multidisciplinary, and anti-rheumatic agents have a prominent role in severe disease. This paper reviews the rationale for the use of anti-rheumatic agents in pediatric COVID-19 and MIS-C and the clinical experience with the single drugs. Finally, the areas of potential improvement in the use of anti-rheumatic agents, including the optimization of the drug choice and the timing of administration, are discussed.https://doi.org/10.1186/s12969-021-00559-5AnakinraCanakinumabCoronavirusChildrenMacrophage activation syndromeMultisystem inflammatory syndrome in children |
| spellingShingle | Giorgio Costagliola Erika Spada Rita Consolini Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents Pediatric Rheumatology Online Journal Anakinra Canakinumab Coronavirus Children Macrophage activation syndrome Multisystem inflammatory syndrome in children |
| title | Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents |
| title_full | Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents |
| title_fullStr | Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents |
| title_full_unstemmed | Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents |
| title_short | Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents |
| title_sort | severe covid 19 in pediatric age an update on the role of the anti rheumatic agents |
| topic | Anakinra Canakinumab Coronavirus Children Macrophage activation syndrome Multisystem inflammatory syndrome in children |
| url | https://doi.org/10.1186/s12969-021-00559-5 |
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