Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, India.
Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq.
BMC Infect Dis. 2024 Aug 21;24(1):847. doi: 10.1186/s12879-024-09581-w.
Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 can lead to severe cardiovascular complications. Anakinra, an interleukin-1 receptor antagonist, is proposed to benefit the hyperinflammatory state of MIS-C, potentially improving cardiac function. This systematic review evaluated the effectiveness of early Anakinra administration on cardiac outcomes in children with MIS-C.
A comprehensive search across PubMed, Embase, and Web of Science until March 2024 identified studies using Anakinra to treat MIS-C with reported cardiac outcomes. Observational cohorts and clinical trials were included, with data extraction focusing on cardiac function metrics and inflammatory markers. Study quality was assessed using the Newcastle-Ottawa Scale.
Six studies met the inclusion criteria, ranging from retrospective cohorts to prospective clinical studies, predominantly from the USA. Anakinra dosages ranged from 2.3 to 10 mg/kg based on disease severity. Several studies showed significant improvements in left ventricular ejection fraction and reductions in inflammatory markers like C-reactive protein, suggesting Anakinra's role in enhancing cardiac function and mitigating inflammation. However, findings on vasoactive support needs were mixed, and some studies did not report significant changes in acute cardiac support requirements.
Early Anakinra administration shows potential for improving cardiac function and reducing inflammation in children with MIS-C, particularly those with severe manifestations. However, the existing evidence is limited by the observational nature of most studies and lacks randomized controlled trials (RCTs). Further high-quality RCTs are necessary to conclusively determine Anakinra's effectiveness and optimize its use in MIS-C management for better long-term cardiac outcomes and standardized treatment protocols.
与 SARS-CoV-2 相关的儿童多系统炎症综合征 (MIS-C) 可导致严重的心血管并发症。白细胞介素-1 受体拮抗剂阿那白滞素被提议用于改善 MIS-C 的过度炎症状态，从而可能改善心功能。本系统评价评估了早期阿那白滞素给药对 MIS-C 患儿心脏结局的有效性。
通过对 PubMed、Embase 和 Web of Science 进行全面检索，截至 2024 年 3 月，确定了使用阿那白滞素治疗 MIS-C 并报告心脏结局的研究。纳入了观察性队列研究和临床试验，数据提取重点关注心脏功能指标和炎症标志物。使用纽卡斯尔-渥太华量表评估研究质量。
符合纳入标准的研究有 6 项，包括回顾性队列研究和前瞻性临床研究，主要来自美国。根据疾病严重程度，阿那白滞素的剂量范围为 2.3 至 10mg/kg。几项研究表明左心室射血分数显著改善，炎症标志物如 C 反应蛋白降低，提示阿那白滞素在增强心功能和减轻炎症方面的作用。然而，关于血管活性支持需求的发现存在差异，一些研究并未报告急性心脏支持需求的显著变化。
早期阿那白滞素给药在改善 MIS-C 患儿心功能和减轻炎症方面显示出一定的潜力，尤其是那些有严重表现的患儿。然而，现有证据受到大多数研究的观察性性质的限制，且缺乏随机对照试验 (RCT)。需要进一步进行高质量的 RCT 以确定阿那白滞素的有效性，并优化其在 MIS-C 管理中的应用，以获得更好的长期心脏结局和标准化治疗方案。
