Early anakinra treatment improves cardiac outcome of multisystem inflammatory syndrome in children regardless of disease severity
Andrea Taddio, Sara Della Paolera, Luisa Abbagnato, Anna Agrusti, Raffaele Badolato, Francesca Biscaro, Roberta Caorsi, Alessandro Consolaro, Rosa Maria Delle Piane, Marianna Fabi, Ilenia Floretta, Marco Gattorno, Manuela Giangreco, Francesco La Torre, Maria Cristina Maggio, Lorenzo Mambelli, Angela Mauro, Maria Vincenza Mastrolia, Alessandra Meneghel, Davide Montin, Francesca Ricci, Gabriele Simonini, Andrea Smarrazzo, Rita Sottile, Sara Stucchi, Maria Tardi, Lucio Verdoni, Gianvincenzo Zuccotti, Fiammetta Zunica, Angelo Ravelli, Marco Cattalini,- Pharmacology (medical)
- Rheumatology
Abstract
Objectives
The main aim of this study was to define the best treatment option for multisystem inflammatory syndrome in children (MIS-C) and to analyze the role of anakinra.
Methods
This is a multicentre retrospective cohort study. Patients were treated according to the attending physician’s decision. The patients were divided in 4 groups on the basis of the first treatment at time of admittance: i) intravenous immunoglobulins (IVIG), ii) IVIG and methylprednisolone (≤ 2 mg/kg/day), iii) IVIG with high dose methylprednisolone (>2 mg/kg/day) and iv) anakinra with or without IVIG and/or methylprednisolone. Primary outcomes were defined as the presence of at least one of the following features: death, the failure of initial treatment, meaning the need of additional treatment for clinical worsening and cardiac involvement at the end of follow-up.
Results
Two hundred thirty-nine patients were recruited. At univariate analysis, persistent heart involvement at discharge was more frequent in those not receiving anakinra as initial treatment (3/21 vs 66/189; p= 0.047). After comparison of the 4 treatment regimens adjusting for the propensity score, we observed that early treatment with anakinra was associated with a lower probability to develop persistent heart disease at the end of follow-up (OR: 0.6; 95% CI: 0.4–1.0).
Conclusion
We report that early treatment with anakinra is safe and very effective in patients with severe MIS-C. In addition, our study suggests that early treatment with anakinra is the most favorable option for patients with a higher risk to develop a severe disease outcome.