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Anakinra in pediatric acute fulminant myocarditis

Louise Maunier1, Ramy Charbel1, Virginie Lambert2,3

  • 1Pediatric Intensive Care and Neonatal Medicine, AP-HP Paris Saclay University, Bicetre Hospital, 78, Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.

Annals of Intensive Care
|August 26, 2022
PubMed

Insights

Interleukin-1 (IL-1) receptor antagonist anakinra shows promise in treating acute fulminant myocarditis in children. This approach led to rapid myocardial function recovery and survival in a small patient group.

Area of Science:

  • Pediatric Cardiology
  • Pediatric Intensive Care
  • Immunology

Background:

  • Acute fulminant myocarditis in children presents significant mortality and morbidity.
  • Limited advancements exist in the medical management of pediatric fulminant myocarditis.
  • This study explores a novel therapeutic approach using IL-1 receptor antagonists.

Purpose of the Study:

  • To evaluate the preliminary efficacy of IL-1 receptor antagonist anakinra in treating children with acute fulminant myocarditis.
  • To assess the impact of anakinra on myocardial function recovery and clinical outcomes.
  • To report on patient characteristics and treatment outcomes in a pediatric intensive care setting.

Main Methods:

  • Retrospective case series of pediatric patients admitted with acute myocarditis.
  • Treatment involved subcutaneous administration of anakinra (IL-1 receptor antagonist).
  • Data collected included patient demographics, clinical presentation, and treatment outcomes.

Main Results:

  • Eight out of ten children with acute fulminant myocarditis received anakinra treatment.
  • Common etiologies included post-infective myocarditis associated with SARS-CoV-2 and MIS-C, and Parvovirus B19.
  • Rapid improvement in myocardial function (within 24 hours) and decreased myocardial enzymes were observed in all treated patients.
  • All patients survived with complete myocardial recovery.

Conclusions:

  • The use of IL-1 receptor antagonist anakinra in the initial management of pediatric acute fulminant myocarditis appears to facilitate rapid stabilization.
  • Anakinra treatment is associated with swift recovery of myocardial function and positive patient outcomes.
  • This pilot study suggests a potential role for IL-1 blockade in managing severe pediatric myocarditis.
Abstract

Keywords:
AnakinraB19 parvovirusCOVID-19ChildrenIL-1 receptor antagonistMIS-CMyocarditisPIMS–TS

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