{"doi":"10.1002/art.42495","title":"Variation in Early Anakinra Use and <scp>Short‐Term</scp> Outcomes in Multisystem Inflammatory Syndrome in Children","abstract":"OBJECTIVE: Evidence regarding effectiveness of interleukin-1 receptor antagonism in multisystem inflammatory syndrome in children (MIS-C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy. METHODS: We conducted a retrospective cohort study of MIS-C cases in a US surveillance registry from November 2020 to December 2021. Day 0 was the first calendar day of immunomodulatory treatment. Factors associated with initial anakinra use (days 0-1) were identified. We compared cases in patients ages 2-20 years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and/or glucocorticoids on days 0-1, using inverse probability weighting to balance disease severity. Primary outcomes were vasopressor requirement on day 3 and impaired left ventricular ejection fraction on days 3-4. The secondary outcome was 50% reduction in C-reactive protein on day 3. RESULTS: Among 1,516 MIS-C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0-74% by site). Site accounted for 59% of residual variance in anakinra use. After balancing disease severity, initial treatment with anakinra plus IVIG and/or glucocorticoids (n = 121) versus IVIG plus glucocorticoids (n = 389) was not associated with significant differences in vasopressor requirement (25.6% versus 20.1%, respectively; risk ratio [RR] 1.27 [95% confidence interval (95% CI) 0.88-1.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98-1.75]), or C-reactive protein reduction. 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.","journal":"Arthritis & Rheumatology","year":2023,"id":357332,"datarank":0.3958585994422889,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.0,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9367,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":690466,"name":"Cameron C. 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Harvey","orcid":null,"position":10,"is_corresponding":false},{"id":376641,"name":"Charlotte V. Hobbs","orcid":"0000-0003-4829-0791","position":11,"is_corresponding":false},{"id":243977,"name":"Mark W. Hall","orcid":null,"position":12,"is_corresponding":false},{"id":242090,"name":"Michele Kong","orcid":"0000-0001-6596-3965","position":13,"is_corresponding":false},{"id":831384,"name":"Cassyanne L. Aguiar","orcid":"0000-0001-8368-4628","position":14,"is_corresponding":false},{"id":236972,"name":"Jennifer E. Schuster","orcid":"0000-0001-6365-566X","position":15,"is_corresponding":false},{"id":260218,"name":"Julie C. Fitzgerald","orcid":"0000-0002-7627-1689","position":16,"is_corresponding":false},{"id":690468,"name":"Aalok R. Singh","orcid":"0000-0002-7186-1882","position":17,"is_corresponding":false},{"id":778563,"name":"Kari Wellnitz","orcid":"0000-0001-9451-8879","position":18,"is_corresponding":false},{"id":451855,"name":"Ryan A. 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