Early anakinra treatment improves cardiac outcome of multisystem inflammatory syndrome in children regardless of disease severity

Rheumatology (Oxford). 2023 Aug 30:kead381. doi: 10.1093/rheumatology/kead381. Online ahead of print.


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.

Keywords: MIS-C; SARS-CoV-2; anakinra; cardiac outcome; children.