Role of Biological Agents in the Treatment of SARS-CoV-2–Associated Multisystem Inflammatory Syndrome in Children

Abstract

Objectives:The aims of this study were to evaluate the role of biological agents in the treatment of severe multisystem inflammatory syndrome in children (MIS-C) and to assess the current application, outcomes, and adverse effects in patients who are followed up in a pediatric intensive care unit (PICU).Patients and Methods: This observational, descriptive, medical records review study was performed on patients with MIS-C admitted to the PICU between September 1 and November 1, 2020. Through medical records review, we confirmed that patients were positive for current or recent SARS-CoV-2 infection or for COVID-19 exposure history within the 4 weeks before the onset of symptoms.Results: A total of 33 patients with severe MIS-C were included (21 male) with a median age of 9 years. The most common signs and symptoms during disease course were fever (100%) and abdominal pain (75.5%). Clinical features of 63.6% patients were consistent with Kawasaki disease/Kawasaki disease shock syndrome, and 36.4% were consistent with secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Myocardial dysfunction and/or coronary artery abnormalities were detected in 18 patients during the PICU stay. Intravenous immunoglobulin and corticosteroids were given to 33 patients. Anakinra was administered to 23 patients (69.6%). There was a significant increase in lymphocyte and platelet counts and a significant decrease in ferritin, B-type natriuretic peptide, and troponin levels at the end of the first week of treatment in patients who were given biological therapy. Two patients were switched to tocilizumab because of an insufficient response to anakinra. The mortality rate of MIS-C patients admitted in PICU was 6.0%.Conclusions: Management of systemic inflammation and shock is important to decrease mortality and the development of persistent cardiac dysfunction in MIS-C. The aggressive treatment approach, including biological agents, may be required in patients with severe symptoms and cardiac dysfunction.

Anakinra treatment in multisystemic inflammatory syndrome in children (MIS-C) associated with COVID-19

“…The median resolution day of the fever was 3 (1-10) days after anakinra treatment. The lymphocyte counts, BNP, CRP, and D-dimer values of the patients became normal on the median day of 5 (1-18), 8.5 (5-53), 10 (1-33), and 11.5 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), respectively. The pattern of improvement in EF…”

Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID‐19

“…Significant increases in lymphocyte and platelet counts and significant decreases in ferritin, BNP and troponin levels were observed at the end of the first week of treatment in patients who were given biological therapy. 23 In addition, studies have emphasised the efficacy of anakinra in adult patients with SARS-CoV-2-associated hyperinflammatory conditions. 20 After treatment with anakinra, the need for vasopressors decreased and respiratory function improved significantly in eight patients with SARS-CoV-2-associated pneumonia who were followed up in the intensive care unit.…”

A Novel and Severe Clinical Picture Related to COVID-19: Multi-Inflammatory Syndrome in Children

“…A male dominance among the patients was shown in several studies. [10][11][12] A systematic review evaluating 917 MIS-C patients showed that the median age of the patients was 9.3 years, and 56.8% of the cases were males. 13 Similarly, male/female ratio was 1.37:1, and the median age was 7.5 years in another systematic review including 992 MIS-C patients.…”