Anakinra in pediatric acute fulminant myocarditis

L. Maunier , R. Charbel , V. Lambert , P. Tissières
{"title":"Anakinra in pediatric acute fulminant myocarditis","authors":"L. Maunier ,&nbsp;R. Charbel ,&nbsp;V. Lambert ,&nbsp;P. Tissières","doi":"10.1016/j.acvdsp.2023.07.031","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Acute fulminant </span>myocarditis<span> in children is associated with elevated mortality and morbidity with few advances in its medical management. In adults with acute myocarditis, activation of the inflammasome through the production of pro-inflammatory mediators such IL-1β, IL-18 is widely recognized.</span></p></div><div><h3>Objective</h3><p>Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery.</p></div><div><h3>Methods</h3><p>A retrospective case series of children admitted to the Pediatric Intensive Care Unit<span> of Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2023 with acute myocarditis. Children were treated with subcutaneous Anakinra (an IL-1 receptor antagonist). Patients’ characteristics, and outcome are reported.</span></p></div><div><h3>Results/Expected results</h3><p><span><span><span>Of twenty-four children admitted with acute fulminant myocarditis, fifteen were treated with sub-cutaneous anakinra. Twelve children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C), one child had Parvovirus B19 myocarditis, one child had idiopathic encephalomyelitis and myocarditis and one child had idiopathic myocarditis. Nine of fifteen children were in </span>cardiogenic shock and needed </span>vasopressor drugs<span><span>, one required central extracorporeal membrane oxygenation<span> (ECMO). Only three of the fifteen children had ventricular arrhythmia, one evolving toward malignant </span></span>ventricular fibrillation. In all treated patients, a rapid (&lt; 24</span></span> <span>h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery except from one who had a heart transplantation (</span><span>Figure 1</span>).</p></div><div><h3>Conclusion/Perspectives</h3><p>In this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 4","pages":"Pages 287-288"},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002525","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction

Acute fulminant myocarditis in children is associated with elevated mortality and morbidity with few advances in its medical management. In adults with acute myocarditis, activation of the inflammasome through the production of pro-inflammatory mediators such IL-1β, IL-18 is widely recognized.

Objective

Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery.

Methods

A retrospective case series of children admitted to the Pediatric Intensive Care Unit of Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2023 with acute myocarditis. Children were treated with subcutaneous Anakinra (an IL-1 receptor antagonist). Patients’ characteristics, and outcome are reported.

Results/Expected results

Of twenty-four children admitted with acute fulminant myocarditis, fifteen were treated with sub-cutaneous anakinra. Twelve children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C), one child had Parvovirus B19 myocarditis, one child had idiopathic encephalomyelitis and myocarditis and one child had idiopathic myocarditis. Nine of fifteen children were in cardiogenic shock and needed vasopressor drugs, one required central extracorporeal membrane oxygenation (ECMO). Only three of the fifteen children had ventricular arrhythmia, one evolving toward malignant ventricular fibrillation. In all treated patients, a rapid (< 24 h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery except from one who had a heart transplantation (Figure 1).

Conclusion/Perspectives

In this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
小儿急性暴发性心肌炎的Anakinra
儿童急性暴发性心肌炎与死亡率和发病率升高相关,其医疗管理进展甚微。在成人急性心肌炎患者中,炎性小体通过产生IL-1β、IL-18等促炎介质而激活已被广泛认可。目的报告IL-1受体拮抗剂治疗儿童心肌功能快速恢复的初步经验。方法对2020年4月至2023年1月期间在巴黎萨克雷大学Bicêtre医院儿科重症监护室住院的急性心肌炎患儿进行回顾性分析。儿童接受皮下Anakinra(一种IL-1受体拮抗剂)治疗。报告患者的特征和结果。结果/预期结果24例急性暴发性心肌炎患儿中,15例接受皮下安纳白注射液治疗。SARS-CoV-2感染后心肌炎合并儿童多系统炎症综合征(MIS-C)患儿12例,细小病毒B19心肌炎患儿1例,特发性脑脊髓炎合并心肌炎患儿1例,特发性心肌炎患儿1例。15名儿童中有9名是心源性休克,需要血管加压药物,1名需要中央体外膜氧合(ECMO)。15名儿童中只有3名患有室性心律失常,1名发展为恶性心室颤动。在所有接受治疗的患者中,快速(<24 h)心肌功能改善,心肌酶降低。除1例接受心脏移植的患者外,所有患者均存活,心肌完全恢复(图1)。结论/观点在这项初步研究中,在儿童急性暴发性心肌炎的初始治疗中使用IL-1受体拮抗剂似乎与快速稳定和恢复有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
期刊最新文献
Editorial Contents How to Report postoperative pediatric cardiac surgery? Review and analysis of the literature Surgical or transcatheter pulmonary valve replacement, how to choose ? No coronary artery in the aorta: Severe congenital malformation under-diagnosed
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1