학술논문
Early anakinra treatment improves cardiac outcome of multisystem inflammatory syndrome in children, regardless of disease severity.
Document Type
Article
Author
Taddio, Andrea; Paolera, Sara Della; Abbagnato, Luisa; Agrusti, Anna; Badolato, Raffaele; Biscaro, Francesca; Caorsi, Roberta; Consolaro, Alessandro; Dellepiane, Rosa Maria; Fabi, Marianna; Floretta, Ilenia; Gattorno, Marco; Giangreco, Manuela; Torre, Francesco La; Maggio, Maria Cristina; Mambelli, Lorenzo; Mauro, Angela; Mastrolia, Maria Vincenza; Meneghel, Alessandra; Montin, Davide
Source
Subject
*PREVENTION of heart diseases
*RESEARCH
*METHYLPREDNISOLONE
*STATISTICS
*MULTISYSTEM inflammatory syndrome
*BIOLOGICAL products
*CONFIDENCE intervals
*HEART
*INTERLEUKIN-1
*ACQUISITION of data
*RETROSPECTIVE studies
*ANTIRHEUMATIC agents
*SEVERITY of illness index
*TREATMENT effectiveness
*INTRAVENOUS immunoglobulins
*TREATMENT failure
*MEDICAL records
*DESCRIPTIVE statistics
*RESEARCH funding
*DEATH
*ODDS ratio
*EARLY medical intervention
*LONGITUDINAL method
*PATIENT safety
*CHEMICAL inhibitors
*EVALUATION
*CHILDREN
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Language
ISSN
1462-0324
Abstract
Objective The main aim of this study was to define the best treatment option for multisystem inflammatory syndrome in children (MIS-C) and to analyse 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 into four groups on the basis of the first treatment at time of admittance: (i) 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 for 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 comparisons between the four treatment regimens, adjusting for the propensity score, we observed that early treatment with anakinra was associated with a lower probability of developing persistent heart disease at the end of follow-up (odds ratio: 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 favourable option for patients with a higher risk of developing a severe disease outcome. [ABSTRACT FROM AUTHOR]