Early anakinra treatment improves cardiac outcome of multisystem inflammatory syndrome in children, regardless of disease severity
Andrea Taddio, Sara Della Paolera, L Abbagnato, Anna Agrusti, Raffaele Badolato, Francesca Biscaro, Roberta Caorsi, Alessandro Consolaro, Rosa Maria Dellepiane, 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, the Italian Society of Pediatric Rheumatology (ReumaPed), P Adamoli, M C Alberelli, Maria Alessio, Clotilde Alizzi, Patrizia Barone, Lucia Augusta Baselli, V. Bennato, Francesca Biscaro, Gianluca Boscarol, Grazia Bossi, Andrea Campana, Simona Campus, Marco Carone, Adele Civino, Giovanni Conti, E Dei Rossi, Ennio Del Giudice, A Dell'Anna, Maia De Luca, Enrico Felici, Giovanni Filocamo, Maria Loreta Foschini, Romina Gallizzi, Salvatore Giordano, Silvia Lanciotti, Bianca Lattanzi, Alessandra Lazzerotti, Francesco Licciardi, Alessandra Manerba, Savina Mannarino, Achille Marino, Agostina Marolda, Laura Martelli, Giorgia Martini, Angelo Mazza, Domenico Minasi, Angela Miniaci, Francesca Minoia, Alma Nunzia Olivieri, Guido Pennoni, R Pignataro, Francesca Ricci, D Rigante, Mariateresa Rossi, C Santagati, M Soliani, Sandra Sonego, Domenico Sperlì, B. Teruzzi, E. Tierno, T Utytatnikova, Piero Valentini, Gianluca Vergine
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.