Recent research on the application of biologics in the treatment of multisystem inflammatory syndrome in children after SARS-CoV-2 infection

CUI Han-Yu, HU Chang-Ping

Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (2) : 216-222.

PDF(564 KB)
PDF(564 KB)
Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (2) : 216-222. DOI: 10.7499/j.issn.1008-8830.2111005
REVIEW

Recent research on the application of biologics in the treatment of multisystem inflammatory syndrome in children after SARS-CoV-2 infection

  • CUI Han-Yu, HU Chang-Ping
Author information +
History +

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a type of hyperinflammatory symptoms similar to Kawasaki disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is commonly observed in children aged 8-10 years. Primary therapeutic medications for MIS-C are intravenous immunoglobulins and glucocorticoids. It has been reported that biologics, such as IL-1 receptor antagonist anakinra, IL-6 receptor antagonist tocilizumab, and TNF-α receptor antagonist infliximab, can be used as an option for critically ill patients. This article elaborates on the mechanism of action of the above biologics and discusses the efficacy and safety biologics in the treatment of MIS-C after SARS-CoV-2 infection, in order to provide methods for the treatment of MIS-C with severe symptoms.

Key words

Multisystem inflammatory syndrome / Severe acute respiratory syndrome coronavirus 2 / Biologics / Child

Cite this article

Download Citations
CUI Han-Yu, HU Chang-Ping. Recent research on the application of biologics in the treatment of multisystem inflammatory syndrome in children after SARS-CoV-2 infection[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(2): 216-222 https://doi.org/10.7499/j.issn.1008-8830.2111005

References

1 World Health Organization. WHO coronavirus (COVID-19)dashboard [EB/OL]. (2021-11-01) [2021-11-01]. https://covid19.who.int/.
2 Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic[J]. Lancet, 2020, 395(10237): 1607-1608. PMID: 32386565. PMCID: PMC7204765. DOI: 10.1016/S0140-6736(20)31094-1.
3 World Health Organization. WHO coronavirus (COVID-19)dashboard [EB/OL]. (2021-11-01) [2021-11-01]. https://app.powerbi.com/.
4 Centers for Disease Control and Prevention. Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States[EB/OL]. (2021-11-01)[2021-11-01]. https://stacks.cdc.gov/view/cdc/104682.
5 Yasuhara J, Watanabe K, Takagi H, et al. COVID-19 and multisystem inflammatory syndrome in children: a systematic review and meta-analysis[J]. Pediatr Pulmonol, 2021, 56(5): 837-848. PMID: 33428826. PMCID: PMC8013394. DOI: 10.1002/ppul.25245.
6 Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents[J]. Lancet Infect Dis, 2020, 20(11): e276-e288. PMID: 32818434. PMCID: PMC7431129. DOI: 10.1016/S1473-3099(20)30651-4.
7 McMurray JC, May JW, Cunningham MW, et al. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis-a critical review of its pathogenesis and treatment[J]. Front Pediatr, 2020, 8: 626182. PMID: 33425823. PMCID: PMC7793714. DOI: 10.3389/fped.2020.626182.
8 Centers for Disease Control and Prevention. Multisystem inflammatory syndrome (MIS)[EB/OL]. (2021-05-20)[2021-05-20]. https://www.cdc.gov/mis/.
9 Lima-Setta F, Magalh?es-Barbosa MCD, Rodrigues-Santos G, et al. Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study[J]. J Pediatr (Rio J), 2021, 97(3): 354-361. PMID: 33186512. PMCID: PMC7649656. DOI: 10.1016/j.jped.2020.10.008.
10 García-Salido A, de Carlos Vicente JC, Belda Hofheinz S, et al. Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain[J]. Crit Care, 2020, 24(1): 666. PMID: 33243303. PMCID: PMC7689392. DOI: 10.1186/s13054-020-03332-4.
11 McCormick DW, Richardson LC, Young PR, et al. Deaths in children and adolescents associated with COVID-19 and MIS-C in the United States[J]. Pediatrics, 2021, 148(5): e2021052273. PMID: 34385349. DOI: 10.1542/peds.2021-052273.
12 Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2[J]. JAMA, 2020, 324(3): 259-269. PMID: 32511692. PMCID: PMC7281356. DOI: 10.1001/jama.2020.10369.
13 Choi NH, Fremed M, Starc T, et al. MIS-C and cardiac conduction abnormalities[J]. Pediatrics, 2020, 146(6): e2020009738. PMID: 33184170. DOI: 10.1542/peds.2020-009738.
14 Lee PY, Day-Lewis M, Henderson LA, et al. Distinct clinical and immunological features of SARS-CoV-2-induced multisystem inflammatory syndrome in children[J]. J Clin Invest, 2020, 130(11): 5942-5950. PMID: 32701511. PMCID: PMC7598077. DOI: 10.1172/JCI141113.
15 Okarska-Napiera?a M, Mańdziuk J, Feleszko W, et al. Recurrent assessment of lymphocyte subsets in 32 patients with multisystem inflammatory syndrome in children (MIS-C)[J]. Pediatr Allergy Immunol, 2021, 32(8): 1857-1865. PMID: 34331778. DOI: 10.1111/pai.13611.
16 Karagol C, Tehci AK, Gungor A, et al. Delta neutrophil index and C-reactive protein: a potential diagnostic marker of multisystem inflammatory syndrome in children (MIS-C) with COVID-19[J]. Eur J Pediatr, 2021. PMID: 34647164. PMCID: PMC8514280. DOI: 10.1007/s00431-021-04281-y. Epub ahead of print.
17 Henderson LA, Canna SW, Friedman KG, et al. American college of rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version2[J]. Arthritis Rheumatol, 2021, 73(4): e13-e29. PMID: 33277976. PMCID: PMC8559788. DOI: 10.1002/art.41616.
18 Felsenstein S, Willis E, Lythgoe H, et al. Presentation, treatment response and short-term outcomes in paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS)[J]. J Clin Med, 2020, 9(10): 3293. PMID: 33066459. PMCID: PMC7602286. DOI: 10.3390/jcm9103293.
19 Ouldali N, Toubiana J, Antona D, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children[J]. JAMA, 2021, 325(9): 855-864. PMID: 33523115. PMCID: PMC7851757. DOI: 10.1001/jama.2021.0694.
20 Kabeerdoss J, Pilania RK, Karkhele R, et al. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management[J]. Rheumatol Int, 2021, 41(1): 19-32. PMID: 33219837. PMCID: PMC7680080. DOI: 10.1007/s00296-020-04749-4.
21 Licciardi F, Baldini L, Dellepiane M, et al. MIS-C treatment: is IVIG always necessary?[J]. Front Pediatr, 2021, 9: 753123. PMID: 34805048. PMCID: PMC8595395. DOI: 10.3389/fped.2021.753123.
22 Vukomanovic V, Krasic S, Prijic S, et al. Recent experience: corticosteroids as a first-line therapy in children with multisystem inflammatory syndrome and COVID-19-related myocardial damage[J]. Pediatr Infect Dis J, 2021, 40(11): e390-e394. PMID: 34260481. PMCID: PMC8505156. DOI: 10.1097/INF.0000000000003260.
23 ?elikel E, Tekin ZE, Aydin F, et al. Role of biological agents in the treatment of SARS-CoV-2-associated multisystem inflammatory syndrome in children[J]. J Clin Rheumatol, 2021. PMID: 33843774. DOI: 10.1097/RHU.0000000000001734. Epub ahead of print.
24 Kooistra EJ, Waalders NJB, Grondman I, et al. Anakinra treatment in critically ill COVID-19 patients: a prospective cohort study[J]. Crit Care, 2020, 24(1): 688. PMID: 33302991. PMCID: PMC7726611. DOI: 10.1186/s13054-020-03364-w.
25 Tanner T, Wahezi DM. Hyperinflammation and the utility of immunomodulatory medications in children with COVID-19[J]. Paediatr Respir Rev, 2020, 35: 81-87. PMID: 32792288. PMCID: PMC7387280. DOI: 10.1016/j.prrv.2020.07.003.
26 Kwak JH, Lee SY, Choi JW, et al. Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019[J]. Clin Exp Pediatr, 2021, 64(2): 68-75. PMID: 33445833. PMCID: PMC7873390. DOI: 10.3345/cep.2020.01900.
27 Della Paolera S, Valencic E, Piscianz E, et al. Case report: use of anakinra in multisystem inflammatory syndrome during COVID-19 pandemic[J]. Front Pediatr, 2020, 8: 624248. PMID: 33708752. PMCID: PMC7940350. DOI: 10.3389/fped.2020.624248.
28 Fouriki A, Fougère Y, De Camaret C, et al. Case report: case series of children with multisystem inflammatory syndrome following SARS-CoV-2 infection in Switzerland[J]. Front Pediatr, 2020, 8: 594127. PMID: 33469522. PMCID: PMC7813982. DOI: 10.3389/fped.2020.594127.
29 Calò Carducci FI, De Ioris MA, Agrati C, et al. Hyperinflammation in two severe acute respiratory syndrome coronavirus 2-infected adolescents successfully treated with the interleukin-1 inhibitor anakinra and glucocorticoids[J]. Front Pediatr, 2020, 8: 576912. PMID: 33330276. PMCID: PMC7734022. DOI: 10.3389/fped.2020.576912.
30 Cirks BT, Geracht JC, Jones OY, et al. Multisystem inflammatory syndrome in children during the COVID-19 pandemic: a case report on managing the hyperinflammation[J]. Mil Med, 2021, 186(1-2): e270-e276. PMID: 33242097. PMCID: PMC7717316. DOI: 10.1093/milmed/usaa508.
31 Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease[J]. Cold Spring Harb Perspect Biol, 2014, 6(10): a016295. PMID: 25190079. PMCID: PMC4176007. DOI: 10.1101/cshperspect.a016295.
32 Gruber CN, Patel RS, Trachtman R, et al. Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C)[J]. Cell, 2020, 183(4): 982-995.e14. PMID: 32991843. PMCID: PMC7489877. DOI: 10.1016/j.cell.2020.09.034.
33 Riollano-Cruz M, Akkoyun E, Briceno-Brito E, et al. Multisystem inflammatory syndrome in children related to COVID-19: a New York city experience[J]. J Med Virol, 2021, 93(1): 424-433. PMID: 32584487. PMCID: PMC7361761. DOI: 10.1002/jmv.26224.
34 Al Maskari N, Al Mukhaini K, Al Abrawi S, et al. SARS-CoV-2-related multisystem inflammatory syndrome in children: a case series[J]. Sultan Qaboos Univ Med J, 2021, 21(2): e302-e307. PMID: 34221480. PMCID: PMC8219337. DOI: 10.18295/squmj.2021.21.02.021.
35 Ni?o-Taravilla C, Espinosa-Vielma YP, Otaola-Arca H, et al. Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 treated with tocilizumab[J]. Pediatr Rep, 2020, 12(3): 142-148. PMID: 33291619. PMCID: PMC7768469. DOI: 10.3390/pediatric12030029.
36 Pettit NN, Nguyen CT, Mutlu GM, et al. Late onset infectious complications and safety of tocilizumab in the management of COVID-19[J]. J Med Virol, 2021, 93(3): 1459-1464. PMID: 32790075. PMCID: PMC7436682. DOI: 10.1002/jmv.26429.
37 Tanaka T, Narazaki M, Masuda K, et al. Regulation of IL-6 in immunity and diseases[J]. Adv Exp Med Biol, 2016, 941: 79-88. PMID: 27734409. DOI: 10.1007/978-94-024-0921-5_4.
38 Dolinger MT, Person H, Smith R, et al. Pediatric Crohn disease and multisystem inflammatory syndrome in children (MIS-C) and COVID-19 treated with infliximab[J]. J Pediatr Gastroenterol Nutr, 2020, 71(2): 153-155. PMID: 32452979. PMCID: PMC7268863. DOI: 10.1097/MPG.0000000000002809.
39 Pourmoghaddas Z, Sadeghizadeh A, Tara SZ, et al. Longitudinally extensive transverse myelitis as a sign of multisystem inflammatory syndrome following COVID-19 infection: a pediatric case report[J]. J Neuroimmunol, 2021, 360: 577704. PMID: 34517154. PMCID: PMC8397488. DOI: 10.1016/j.jneuroim.2021.577704.
40 Abdel-Haq N, Asmar BI, Deza Leon MP, et al. SARS-CoV-2-associated multisystem inflammatory syndrome in children: clinical manifestations and the role of infliximab treatment[J]. Eur J Pediatr, 2021, 180(5): 1581-1591. PMID: 33452570. PMCID: PMC7810600. DOI: 10.1007/s00431-021-03935-1.
41 Shikhare AR, Iqbal RM, Tariq R, et al. Diversity of cardiac and gastrointestinal presentations of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19: a case series[J]. Glob Pediatr Health, 2021, 8: 2333794X21996613. PMID: 33748343. PMCID: PMC7903818. DOI: 10.1177/2333794X21996613.
42 Navaeifar MR, Shahbaznejad L, Sadeghi Lotfabadi A, et al. COVID-19-associated multisystem inflammatory syndrome complicated with giant coronary artery aneurysm[J]. Case Rep Pediatr, 2021, 2021: 8836403. PMID: 33505752. PMCID: PMC7798113. DOI: 10.1155/2021/8836403.
43 Consiglio CR, Cotugno N, Sardh F, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19[J]. Cell, 2020, 183(4): 968-981.e7. PMID: 32966765. PMCID: PMC7474869. DOI: 10.1016/j.cell.2020.09.016.
44 Sperotto F, Friedman KG, Son MBF, et al. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach[J]. Eur J Pediatr, 2021, 180(2): 307-322. PMID: 32803422. PMCID: PMC7429125. DOI: 10.1007/s00431-020-03766-6.
45 Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of COVID-19 in nonhospitalized patients[J]. N Engl J Med, 2021. PMID: 34914868. DOI: 10.1056/NEJMoa2116044. Epub ahead of print.
46 Bautista-Rodriguez C, Sanchez-de-Toledo J, Clark BC, et al. Multisystem inflammatory syndrome in children: an international survey[J]. Pediatrics, 2021, 147(2): e2020024554. PMID: 33234669. DOI: 10.1542/peds.2020-024554.
47 Panigrahy N, Policarpio J, Ramanathan R. Multisystem inflammatory syndrome in children and SARS-CoV-2: a scoping review[J]. J Pediatr Rehabil Med, 2020, 13(3): 301-316. PMID: 33252101. DOI: 10.3233/PRM-200794.
PDF(564 KB)

Accesses

Citation

Detail

Sections
Recommended

/