Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study

Brian L. Dizon, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Christopher Redmond, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Emily C. Gotschlich, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Sangeeta Sule, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Tova Ronis, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Kathleen M. Vazzana, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Matthew A. Sherman, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Rachael Connor, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Abigail Bosk, Division of Rheumatology, Children's National Hospital, Washington, DC, USA.
Niti Dham, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Ashraf S. Harahsheh, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Elizabeth Wells, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Roberta DeBiasi, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Hemalatha Srinivasalu, Division of Rheumatology, Children's National Hospital, Washington, DC, USA. HSriniva@childrensnational.org.

Document Type

Journal Article

Publication Date

7-31-2023

Journal

Pediatric rheumatology online journal

Volume

21

Issue

1

DOI

10.1186/s12969-023-00858-z

Keywords

Anakinra; Cardiac dysfunction; Multisystem inflammatory syndrome in children; SARS-CoV2; Therapy

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.

Department

Pediatrics

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