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

作者：Brian 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 L. DeBiasi, Hemalatha Srinivasalu · 发表于：Pediatric Rheumatology · 年份：2023 · DOI：10.1186/s12969-023-00858-z · 被引用次数：12 · 研究领域：Kawasaki Disease and Coronary Complications、Autoimmune and Inflammatory Disorders Research、Macrophage Migration Inhibitory Factor

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 wi...