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Intravenous administration of anakinra in children with macrophage activation syndrome
Omkar Phadke1,2, Kelly Rouster-Stevens3,4, Helen Giannopoulos4
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. ophadke@emory.edu.
Insights
Intravenous anakinra effectively treats severe pediatric inflammatory conditions like macrophage activation syndrome. This treatment showed significant patient improvement with no adverse reactions, offering a vital alternative to subcutaneous injections.
Area of Science:
- Immunology
- Pediatric Rheumatology
- Critical Care Medicine
Background:
- Subcutaneous anakinra (interleukin-1 inhibitor) treats juvenile idiopathic arthritis.
- Anakinra shows promise for COVID-19 cytokine storm and MIS-C in children.
- This study explores intravenous anakinra administration.
Purpose of the Study:
- To evaluate the safety and efficacy of intravenous anakinra.
- To assess its utility in critically ill pediatric patients.
- To explore benefits beyond traditional subcutaneous use.
Main Methods:
- Retrospective analysis of 19 patients receiving intravenous anakinra.
- Treatment for macrophage activation syndrome (MAS) secondary to SLE, SJIA, or sHLH.
- Monitoring of clinical and laboratory parameters including fibrinogen, ferritin, AST, and platelets.
Main Results:
- Intravenous anakinra improved key markers (fibrinogen, ferritin, AST, platelets) in most patients.
- No anaphylaxis or administration-related reactions were reported.
- Positive outcomes observed in patients with MAS/HLH.
Conclusions:
- Intravenous anakinra is a valuable therapeutic option for critically ill patients with MAS/HLH.
- Benefits include improved thrombocytopenia, edema, and neurological dysfunction.
- Offers an alternative for young, hospitalized patients requiring frequent injections.
Background:
Subcutaneous anakinra is an interleukin-1 inhibitor used to treat juvenile idiopathic arthritis. Recent reports suggest anakinra can be a valuable addition to the treatment of COVID-19 associated cytokine storm syndrome and the related multisystem inflammatory syndrome (MIS-C) in children. Herein, we describe our experience with intravenously administered anakinra.
Findings:
19 Patients (9 male) received intravenous (IV) anakinra for treatment of macrophage activation syndrome (MAS) secondary to systemic lupus erythematosus (SLE), systemic JIA (SJIA) or secondary hemophagocytic lymphohistiocytosis (sHLH). In most cases the general trend of the fibrinogen, ferritin, AST, and platelet count (Ravelli criteria) improved after initiation of IV anakinra. There were no reports of anaphylaxis or reactions associated with administration of IV anakinra.
Conclusion:
Intravenous administration of anakinra is an important therapeutic option for critically ill patients with MAS/HLH. It is also beneficial for those with thrombocytopenia, subcutaneous edema, neurological dysfunction, or very young, hospitalized patients who need multiple painful subcutaneous injections.
