Case Report: Use of Anakinra in Multisystem Inflammatory Syndrome During COVID-19 Pandemic

Paolera, Sara Della; Valencic, Erica; Piscianz, Elisa; Moressa, Valentina; Tommasini, Alberto; Sagredini, Raffaella; Kiren, Valentina; Comar, Manola; Taddio, Andrea

doi:10.3389/fped.2020.624248

Cited by 29 publications

(25 citation statements)

References 34 publications

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“…More recently, case reports and case series of patients with MIS-C reported the efficacy of treatment with anakinra, highlighting its role particularly in those children who have insufficient response to IVIG and systemic glucocorticoids ( 29 – 31 ).…”

Section: Discussionmentioning

confidence: 99%

Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

et al. 2021

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In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at admission. Patients were initially assigned to four severity classes on admission and treated accordingly. The therapeutic options ranged from IV immunoglobulin alone to a combination of IVIG plus pulses of methylprednisolone plus anakinra for patients with marked cardiac function impairment or signs of macrophage activation syndrome, with rapid treatment escalation in case of inadequate therapeutic response. With the application of this therapeutic strategy, no patient required admission to Intensive Care Unit (ICU) or invasive mechanical ventilation, and no inotropic drugs administration was required. Early aggressive treatment of MIS-C, with therapeutic interventions modulated based on the severity of clinical manifestations may help to prevent the progression of the inflammatory process and to avoid the need of admission to the ICU. A timely intervention with anti-IL-1 blockers can play a pivotal role in very severe patients that are at risk to have an incomplete response to immunoglobulins and steroids.

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Section: Discussionmentioning

confidence: 99%

Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

et al. 2021

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“…Anakinra has been largely used and studied in the treatment of COVID-19 and is part of several clinical trials for this disease [ 13 , 14 , 15 ]; furthermore, its use has been described in a series of MIS-C cases, with good results [ 16 ]. Interestingly, successful use of anakinra in two cases of MIS-C refractive to IVIG and systemic glucocorticoids has also recently been described [ 17 ]. It could therefore prove useful for the treatment of MIS-A, a clinical entity for which established clinical practices are still foggy.…”

Section: Discussionmentioning

confidence: 99%

Multisystem Inflammatory Syndrome in an Adult (MIS-A) Successfully Treated with Anakinra and Glucocorticoids

et al. 2021

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During the current SARS-CoV-2 pandemic, a novel syndrome termed “multisystem inflammatory syndrome in children” (MIS-C) has emerged. MIS-C was linked to COVID-19 and shared some features with Kawasaki disease and Toxic Shock Syndrome, with a common pathogenetic substrate of hyperinflammation and cytokine storm. Lately, MIS was also described in adults (≥21 years of age) and named “MIS-A”. There is no consensus about the treatment of MIS-A; successful use of glucocorticoids and immunoglobulins has been reported in case series, but more solid evidence is lacking. Furthermore, the role of biologic agents with proven benefits against COVID-19, MIS-C, or Kawasaki disease is still unexplored. In this report, we detail the clinical picture and the diagnostic process that led to the diagnosis of MIS-A in a 27-year-old man, focusing on its treatment with anakinra and glucocorticoids, which resulted in full recovery. To our knowledge, this is the first report of the successful use of anakinra for MIS-A, a drug that has already proven useful in the treatment of refractive cases of MIS-C. Anakinra may also play a pivotal role for the treatment of MIS-A.

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“…Anakinra is an IL-1 receptor antagonist that has been previously been shown to be effective with limited side effects in KD patients [57]. Multiple studies have shown anakinra to be similarly effective in MIS-C, especially when it comes to cardiac function, after failure or poor response to IVIG and steroid treatment [58][59][60]. In two large cohorts, anakinra was used in 24/186 and 8/183 patients to good effect [11, 13•].…”

Section: Immunomodulatory Therapiesmentioning

confidence: 99%

Who Would Have Predicted Multisystem Inflammatory Syndrome in Children?

Reiff

Cron

2022

Curr Rheumatol Rep

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Purpose of Review Multisystem inflammatory disease in children (MIS-C) is a novel post-infectious phenomenon following coronavirus disease-19 . Herein, we present an in-depth review of the latest MIS-C literature related to clinical findings, pathophysiology, imaging and laboratory studies, treatment algorithms, and disease outcomes.Recent Findings With its non-specific presentation of fever, gastrointestinal symptoms, cardiovascular injury and shock, systemic inflammation, and Kawasaki disease (KD)-like features, MIS-C can be a diagnostic challenge, overlapping with KD and active COVID-19 infection. However, common laboratory features, imaging findings, and historical clues can lead to accurate diagnosis and allow for appropriate treatment with a variety of immunomodulatory therapies, including intravenous immunoglobulin (IVIG). Aggressive treatment of MIS-C leads to good outcomes. Longitudinal studies continue to illuminate long-term cardiac sequelae and recovery. Summary MIS-C presents with fever, KD features, gastrointestinal symptoms, cardiac inflammation, and shock. Early recognition and prompt institution of IVIG and glucocorticoids provide for rapid improvement.

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Case Report: Use of Anakinra in Multisystem Inflammatory Syndrome During COVID-19 Pandemic

Cited by 29 publications

References 34 publications

Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

Timely Recognition and Early Multi-Step Antinflammatory Therapy May Prevent ICU Admission of Patients With MIS-C: Proposal for a Severity Score

Multisystem Inflammatory Syndrome in an Adult (MIS-A) Successfully Treated with Anakinra and Glucocorticoids

Who Would Have Predicted Multisystem Inflammatory Syndrome in Children?

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