Panda Prateek Kumar, Sharawat Indar Kumar, Natarajan Vivekanand, Bhakat Rahul, Panda Pragnya, Dawman Lesa
Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Medicine, SCB Medical College, Cuttack, Odisha, India.
J Family Med Prim Care. 2021 Sep;10(9):3292-3302. doi: 10.4103/jfmpc.jfmpc_2583_20. Epub 2021 Sep 30.
Exact information about the efficacy of various medications proposed by regulatory bodies in children with COVID-19 is limited due to the lack of controlled trials in the existing literature.
Different electronic databases (MEDLINE, EMBASE, Web of Science, COCHRANE CENTRAL, LitCovid, medRxiv, and bioRxiv) were searched for articles describing the management of COVID-19 cases in children with 18 shortlisted medications. Prospective/retrospective studies/case series (with at least 20 cases) reporting COVID-19 in patients aged ≤14 years were searched to collect information regarding clinical details and severity of participants, medications used, and outcome. The pooled estimate of these parameters across studies was performed using a random-effect or fixed-effect meta-analysis depending on the degree of heterogeneity.
From a total of 5794 records, 97 studies/case series (8243 patients) fulfilled the eligibility criteria and were included in this systematic review. A total of 21% children received at least one medication specifically used for COVID-19. While antivirals were used in 15.3% of children, remedesivir was the most commonly used antiviral drug in 6.2% of included children without many reports of serious adverse effects. There was a more prevalent use of anti-inflammatory medications including corticosteroids (27.8%, = 0.01). Total 91% of severe cases described in literature in children received some anti-inflammatory medications. Among them, corticosteroids (17%) and Intravenous immune globulin (IVIG) (17.5%) were the most predominant followed by interferon (4.2%), tocilizumab (1.5%), and anakinra (0.8%). The most predominant therapy among multisystem inflammatory syndrome in children (MIS-C) cases were IVIG (81%), followed by aspirin (67%), corticosteroids (64%), inotropes (62%), and anticoagulation (56%, mostly low molecular weight heparin, LMWH). Overall mortality was only 1.3%, but when we analyzed separately including only cases with moderate and severe disease, the mortality rate was 4.6%.
Among pharmacological modalities, anti-inflammatory agents like corticosteroids and antivirals like remdesivir have the most promising evidence for severe cases of pediatric COVID-19. Intravenous immunoglobulin and other anti-inflammatory/immunomodulatory agents like anakinra, aspirin, and anticoagulants have important therapeutic role in cases with MIS-C. Most of the mild cases recover with conservative treatment only.
由于现有文献中缺乏对照试验，监管机构提议的各种药物对儿童新冠肺炎疗效的确切信息有限。
检索不同的电子数据库（MEDLINE、EMBASE、科学网、Cochrane中心、LitCovid、medRxiv和bioRxiv），查找描述使用18种入围药物治疗儿童新冠肺炎病例的文章。检索前瞻性/回顾性研究/病例系列（至少20例），这些研究报告了年龄≤14岁患者的新冠肺炎情况，以收集有关参与者的临床细节和严重程度、使用的药物以及结局的信息。根据异质性程度，使用随机效应或固定效应荟萃分析对这些研究中的参数进行汇总估计。
在总共5794条记录中，97项研究/病例系列（8243例患者）符合纳入标准并被纳入本系统评价。共有21%的儿童接受了至少一种专门用于新冠肺炎的药物。15.3%的儿童使用了抗病毒药物，其中瑞德西韦是最常用的抗病毒药物，在6.2%的纳入儿童中使用，且严重不良反应报告较少。抗炎药物的使用更为普遍，包括皮质类固醇（27.8%，P = 0.01）。文献中描述的儿童重症病例中，91%接受了某种抗炎药物治疗。其中，皮质类固醇（17%）和静脉注射免疫球蛋白（IVIG）（17.5%）最为主要，其次是干扰素（4.2%）、托珠单抗（1.5%）和阿那白滞素（0.8%）。儿童多系统炎症综合征（MIS-C）病例中最主要的治疗方法是IVIG（81%），其次是阿司匹林（67%）、皮质类固醇（64%）、血管活性药物（62%）和抗凝治疗（56%，大多为低分子肝素，LMWH）。总体死亡率仅为1.3%，但当我们仅分析中度和重度疾病病例时，死亡率为4.6%。
在药物治疗方式中，皮质类固醇等抗炎药物和瑞德西韦等抗病毒药物对儿童新冠肺炎重症病例最具前景。静脉注射免疫球蛋白以及阿那白滞素、阿司匹林和抗凝剂等其他抗炎/免疫调节药物在MIS-C病例中具有重要治疗作用。大多数轻症病例仅通过保守治疗即可康复。
