Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study
Pediatric rheumatology online journal
Anakinra; Cardiac dysfunction; Multisystem inflammatory syndrome in children; SARS-CoV2; Therapy
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.
Dizon, Brian L.; Redmond, Christopher; Gotschlich, Emily C.; Sule, Sangeeta; Ronis, Tova; Vazzana, Kathleen M.; Sherman, Matthew A.; Connor, Rachael; Bosk, Abigail; Dham, Niti; Harahsheh, Ashraf S.; Wells, Elizabeth; DeBiasi, Roberta; and Srinivasalu, Hemalatha, "Clinical outcomes and safety of anakinra in the treatment of multisystem inflammatory syndrome in children: a single center observational study" (2023). GW Authored Works. Paper 3008.