Anakinra in pediatric acute fulminant myocarditis

Abstract

Background Acute fulminant myocarditis in children is associated with elevated mortality and morbidity with few advances in its medical management. Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery. Methods A retrospective case series of children admitted in the Pediatric Intensive Care Unit of the Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2022 with acute myocarditis. Children were treated with subcutaneous anakinra (an IL-1 receptor antagonist). Patients characteristics, and outcome are reported. Results Of 10 children admitted with acute fulminant myocarditis, eight were treated with sub-cutaneous anakinra. Seven children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C) and one child Parvovirus B19 myocarditis. In all patients a rapid (< 24 h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery. Conclusions In this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.

Multisystem inflammatory syndrome in children during the COVID-19 waves: data from the Juvenile Inflammatory Rheumatism cohort

“…Of interest, the use of biotherapies did not increase over the waves. A French team showed that use of anakinra was associated with a rapid stabilization and recovery in seven patients with acute fulminant myocarditis in an MIS-C setting ( 25 ).…”

Current treatment and immunomodulation strategies in Acute Myocarditis

“…Several nonconventional forms of immunosuppression have been proposed or are under investigation to determine their potential benefits in the context of AM. These include recombinant cytokine receptor antagonists such as anakinra [73][74][75] or lymphocyte components involved in the inflammatory process in myocarditis. Noncorticosteroid immunosuppressants including AZA, 69,76,77 MTX, 78 and cyclosporine 67 have also been proposed for use in the management of myocarditis.…”

“…79 Case reports and case series have suggested that anakinra, a recombinant human IL-1 receptor antagonist, may promote LV function recovery in both adults and children with lymphocytic AM. 73,74 More robust evidence on treatment of AM with anakinra comes from the Anakinra versus Placebo for the Treatment of Acute Myocarditis (ARAMIS) trial, which is now completed and has compared anakinra in addition to standard therapy versus standard therapy alone in admitted patients with AM (NCT03018834). 75 Results from the ARAMIS trial showed that Anakinra is safe for use but does not reduce the complications of myocarditis in a relatively low risk population.…”

Mechanical Circulatory Support Systems in Fulminant Myocarditis: Recent Advances and Outlook

“…Furthermore, many patients received Remdesivir or Hydroxy-chloroquine [ 33 ]. Finally, Maunier et al emphasised the possible therapeutic value of Anakinra in 7 paediatric cases of COVID-19-associated FM [ 106 ]. An overview of the specific subtypes of FM, the role of MCS, and additional treatment options are depicted in Table 2 .…”