Pediatric Rheumatology Online Journal (Jul 2023)

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

  • 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

DOI
https://doi.org/10.1186/s12969-023-00858-z
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 8

Abstract

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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.

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