Variation in Early Anakinra Use and Short‐Term Outcomes in Multisystem Inflammatory Syndrome in Children
Main finding · Vasopressor requirementResult — go to the resultRelative risk 1.27 95% CI 0.88–1.84Authors' 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.
Study context
- Population
- Multisystem inflammatory syndrome in children (MIS-C) cases in a US surveillance registry, November 2020 to December 2021; comparison in patients ages 2–20 years
- Participants
- 1,516 cases44 sites
- Exposure
- Anakinra plus intravenous immunoglobulin (IVIG) and/or GC vs IVIG plus GC on days 0-1
- Anakinra plus IVIG and/or glucocorticoidsn = 121
- IVIG plus glucocorticoidsn = 389reference
- Outcome
- Vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3-4
- Follow-up
- Days 3-4
Methodological detailsinverse probability weighting to balance disease severity, US surveillance registry, 44 sites
- Inverse probability weighting to balance disease severity
- US surveillance registry
- 44 sites
Main finding
Vasopressor requirement · day 3
Relative risk
1.27
95% CI 0.88–1.84
By group
Anakinra plus IVIG and/or glucocorticoidsvs IVIG plus glucocorticoids
RR 1.27 (95% CI 0.88–1.84)
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Anakinra plus IVIG and/or glucocorticoids | IVIG plus glucocorticoids | RR (95% CI) | |
|---|---|---|---|---|
| Co-primary: ventricular dysfunction (impaired LV ejection fraction) · days 3-4After balancing disease severity | 33.7% | 25.7% | 1.31 (0.98–1.75) | |
| 0.512Relative risk (log scale) |
50% reduction in CRP on day 3
- Not associated with significant differences
Initial anakinra use (days 0-1)
- Patients receiving anakinra alone or with other immunomodulators as initial treatment
- 193 (13%)
- Range by site
- 0-74%
- Residual variance in anakinra use accounted for by site
- 59%
Original publication
Variation in Early Anakinra Use and Short‐Term Outcomes in Multisystem Inflammatory Syndrome in Children. Arthritis Rheumatol. Published 16 May 2023. doi:10.
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