TY - JOUR
T1 - Variation in Early Anakinra Use and Short-Term Outcomes in Multisystem Inflammatory Syndrome in Children
AU - the Overcoming COVID-19 Investigators
AU - Chang, Joyce C.
AU - Young, Cameron C.
AU - Muscal, Eyal
AU - Sexson Tejtel, Sara K.
AU - Newhams, Margaret M.
AU - Kucukak, Suden
AU - Crandall, Hillary
AU - Maddux, Aline B.
AU - Rowan, Courtney M.
AU - Halasa, Natasha B.
AU - Harvey, Helen
AU - Hobbs, Charlotte V.
AU - Hall, Mark W.
AU - Kong, Michele
AU - Aguiar, Cassyanne L.
AU - Schuster, Jennifer E.
AU - Fitzgerald, Julie C.
AU - Singh, Aalok R.
AU - Wellnitz, Kari
AU - Nofziger, Ryan A.
AU - Cvijanovich, Natalie Z.
AU - Mack, Elizabeth H.
AU - Schwarz, Adam J.
AU - Heidemann, Sabrina M.
AU - Newburger, Jane W.
AU - Zambrano, Laura D.
AU - Campbell, Angela P.
AU - Patel, Manish M.
AU - Randolph, Adrienne G.
AU - Son, Mary Beth F.
AU - Kong, Michele
AU - Sanders, Ronald C.
AU - Irby, Katherine
AU - Schwarz, Adam J.
AU - Babbitt, Christopher J.
AU - Cvijanovich, Natalie Z.
AU - Zinter, Matt S.
AU - Harvey, Helen
AU - Pannaraj, Pia S.
AU - Maddux, Aline B.
AU - Port, Emily
AU - Shankman, Sara
AU - Mansour, Rachel
AU - Carroll, Christopher L.
AU - Giuliano, John S.
AU - McLaughlin, Gwenn E.
AU - Espinal, Paula S.
AU - Michelson, Kelly N.
AU - Coates, Bria M.
AU - Fitzgerald, Julie C.
N1 - Publisher Copyright:
© 2023 American College of Rheumatology.
PY - 2023/8
Y1 - 2023/8
N2 - Objective: Evidence regarding effectiveness of interleukin-1 receptor antagonism in multisystem inflammatory syndrome in children (MIS-C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy. Methods: We conducted a retrospective cohort study of MIS-C cases in a US surveillance registry from November 2020 to December 2021. Day 0 was the first calendar day of immunomodulatory treatment. Factors associated with initial anakinra use (days 0–1) were identified. We compared cases in patients ages 2–20 years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and/or glucocorticoids on days 0–1, using inverse probability weighting to balance disease severity. Primary outcomes were vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3–4. The secondary outcome was 50% reduction in C-reactive protein on day 3. Results: Among 1,516 MIS-C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0–74% by site). Site accounted for 59% of residual variance in anakinra use. After balancing disease severity, initial treatment with anakinra plus IVIG and/or glucocorticoids (n = 121) versus IVIG plus glucocorticoids (n = 389) was not associated with significant differences in vasopressor requirement (25.6% versus 20.1%, respectively; risk ratio [RR] 1.27 [95% confidence interval (95% CI) 0.88–1.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98–1.75]), or C-reactive protein reduction. Conclusion: We identified substantial variation in initial anakinra use in a real-world population of children with MIS-C, but no average short-term improvement in cardiovascular outcomes associated with early addition of anakinra to IVIG and/or glucocorticoids compared to IVIG and glucocorticoids alone.
AB - Objective: Evidence regarding effectiveness of interleukin-1 receptor antagonism in multisystem inflammatory syndrome in children (MIS-C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy. Methods: We conducted a retrospective cohort study of MIS-C cases in a US surveillance registry from November 2020 to December 2021. Day 0 was the first calendar day of immunomodulatory treatment. Factors associated with initial anakinra use (days 0–1) were identified. We compared cases in patients ages 2–20 years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and/or glucocorticoids on days 0–1, using inverse probability weighting to balance disease severity. Primary outcomes were vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3–4. The secondary outcome was 50% reduction in C-reactive protein on day 3. Results: Among 1,516 MIS-C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0–74% by site). Site accounted for 59% of residual variance in anakinra use. After balancing disease severity, initial treatment with anakinra plus IVIG and/or glucocorticoids (n = 121) versus IVIG plus glucocorticoids (n = 389) was not associated with significant differences in vasopressor requirement (25.6% versus 20.1%, respectively; risk ratio [RR] 1.27 [95% confidence interval (95% CI) 0.88–1.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98–1.75]), or C-reactive protein reduction. Conclusion: We identified substantial variation in initial anakinra use in a real-world population of children with MIS-C, but no average short-term improvement in cardiovascular outcomes associated with early addition of anakinra to IVIG and/or glucocorticoids compared to IVIG and glucocorticoids alone.
UR - https://www.scopus.com/pages/publications/85159628849
U2 - 10.1002/art.42495
DO - 10.1002/art.42495
M3 - Article
C2 - 36908050
AN - SCOPUS:85159628849
SN - 2326-5191
VL - 75
SP - 1466
EP - 1476
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 8
ER -