Use of Continuous Intravenous Anakinra Infusion in Multisystem Inflammatory Syndrome in Children

Overview

Journal Case Rep Crit Care

Publisher Wiley

Specialty Critical Care

Date 2023 Mar 10

PMID 36895203

Authors

Abdulaziz Alolayan

Abdullah S Aldamegh

Azzah AlKhayrat

Affiliations

Soon will be listed here.

Abstract

Coronavirus disease (COVID-19) is an emergency pandemic with a high mortality rate worldwide. One of its complications in children is developing multisystemic inflammatory syndrome related to cytokine storm. Anakinra is a recombinant human interleukin-1 (IL-1) receptor antagonist used to suppress the exaggerated inflammatory response in such conditions, and it is potentially lifesaving in a cytokine storm. We present the case of a patient with critical COVID-19 associated with multisystem inflammatory syndrome in children (MIS-C) successfully treated with anakinra intravenous (IV) infusion.

References

Schmitz N, Kurrer M, Bachmann M, Kopf M . Interleukin-1 is responsible for acute lung immunopathology but increases survival of respiratory influenza virus infection. J Virol. 2005; 79(10):6441-8. PMC: 1091664. DOI: 10.1128/JVI.79.10.6441-6448.2005. View

Khani E, Shahrabi M, Rezaei H, Pourkarim F, Afsharirad H, Solduzian M . Current evidence on the use of anakinra in COVID-19. Int Immunopharmacol. 2022; 111:109075. PMC: 9296834. DOI: 10.1016/j.intimp.2022.109075. View

Dimopoulos G, de Mast Q, Markou N, Theodorakopoulou M, Komnos A, Mouktaroudi M . Favorable Anakinra Responses in Severe Covid-19 Patients with Secondary Hemophagocytic Lymphohistiocytosis. Cell Host Microbe. 2020; 28(1):117-123.e1. PMC: 7221383. DOI: 10.1016/j.chom.2020.05.007. View

Fisher Jr C, Dhainaut J, Opal S, Pribble J, Balk R, Slotman G . Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. Phase III rhIL-1ra Sepsis Syndrome Study Group. JAMA. 1994; 271(23):1836-43. View

Huet T, Beaussier H, Voisin O, Jouveshomme S, Dauriat G, Lazareth I . Anakinra for severe forms of COVID-19: a cohort study. Lancet Rheumatol. 2020; 2(7):e393-e400. PMC: 7259909. DOI: 10.1016/S2665-9913(20)30164-8. View

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M . An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020; 395(10239):1771-1778. PMC: 7220177. DOI: 10.1016/S0140-6736(20)31103-X. View

Galea J, Ogungbenro K, Hulme S, Greenhalgh A, Aarons L, Scarth S . Intravenous anakinra can achieve experimentally effective concentrations in the central nervous system within a therapeutic time window: results of a dose-ranging study. J Cereb Blood Flow Metab. 2010; 31(2):439-47. PMC: 3049499. DOI: 10.1038/jcbfm.2010.103. View

Granowitz E, Porat R, Mier J, Pribble J, Stiles D, Bloedow D . Pharmacokinetics, safety and immunomodulatory effects of human recombinant interleukin-1 receptor antagonist in healthy humans. Cytokine. 1992; 4(5):353-60. DOI: 10.1016/1043-4666(92)90078-6. View

Belhadjer Z, Meot M, Bajolle F, Khraiche D, Legendre A, Abakka S . Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation. 2020; 142(5):429-436. DOI: 10.1161/CIRCULATIONAHA.120.048360. View

10.

Whittaker E, Bamford A, Kenny J, Kaforou M, Jones C, Shah P . Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020; 324(3):259-269. PMC: 7281356. DOI: 10.1001/jama.2020.10369. View

11.

Wolfler A, Mannarino S, Giacomet V, Camporesi A, Zuccotti G . Acute myocardial injury: a novel clinical pattern in children with COVID-19. Lancet Child Adolesc Health. 2020; 4(8):e26-e27. PMC: 7263818. DOI: 10.1016/S2352-4642(20)30168-1. View

12.

Feldstein L, Rose E, Horwitz S, Collins J, Newhams M, Son M . Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020; 383(4):334-346. PMC: 7346765. DOI: 10.1056/NEJMoa2021680. View

13.

Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F . Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020; 369:m2094. PMC: 7500538. DOI: 10.1136/bmj.m2094. View

14.

Ramirez J, Canete J . Anakinra for the treatment of rheumatoid arthritis: a safety evaluation. Expert Opin Drug Saf. 2018; 17(7):727-732. DOI: 10.1080/14740338.2018.1486819. View

15.

Grimaud M, Starck J, Levy M, Marais C, Chareyre J, Khraiche D . Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Ann Intensive Care. 2020; 10(1):69. PMC: 7266128. DOI: 10.1186/s13613-020-00690-8. View

16.

Monteagudo L, Boothby A, Gertner E . Continuous Intravenous Anakinra Infusion to Calm the Cytokine Storm in Macrophage Activation Syndrome. ACR Open Rheumatol. 2020; 2(5):276-282. PMC: 7231518. DOI: 10.1002/acr2.11135. View

17.

Tanner T, Wahezi D . Hyperinflammation and the utility of immunomodulatory medications in children with COVID-19. Paediatr Respir Rev. 2020; 35:81-87. PMC: 7387280. DOI: 10.1016/j.prrv.2020.07.003. View

18.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. PMC: 7159299. DOI: 10.1016/S0140-6736(20)30183-5. View

19.

Chiotos K, Bassiri H, Behrens E, Blatz A, Chang J, Diorio C . Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series. J Pediatric Infect Dis Soc. 2020; 9(3):393-398. PMC: 7313950. DOI: 10.1093/jpids/piaa069. View

20.

Grasselli G, Pesenti A, Cecconi M . Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020; 323(16):1545-1546. DOI: 10.1001/jama.2020.4031. View