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

• Published in: Pediatric Rheumatology Vol. 21; no. 1; p. 76
• Main Authors: Dizon, Brian L P, 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, Srinivasalu, Hemalatha
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.07.2023; BioMed Central; BMC
• Subjects: Algorithms; Anakinra; Cardiac dysfunction; Care and treatment; Children; Clinical outcomes; Comparative analysis; COVID-19; Cytokines; Drug dosages; Fever; Health aspects; Heart; Humans; Immunoglobulins, Intravenous - adverse effects; Inflammation; Interleukin 1 Receptor Antagonist Protein - adverse effects; Kawasaki disease; Medical research; Medicine, Experimental; Multisystem inflammatory syndrome in children; Observational studies; Patient outcomes; Patients; Pediatric cardiology; Pediatrics; Safety and security measures; SARS-CoV2; Systemic Inflammatory Response Syndrome - drug therapy; Therapy; Illinois; SARS-CoV2; Therapy; Multisystem inflammatory syndrome in children; Anakinra; Cardiac dysfunction
• ISSN: 1546-0096; 1546-0096
• DOI: 10.1186/s12969-023-00858-z

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. 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). 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. 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.