Table 1.
Characteristics of included studies
| Author | Year | Country | Study Design | Study Population | Total participants | Mean (SD) or median (IQR) age | MIS diagnosis criteria | Number of patients with anakinra treatment | Dose and frequency of anakinra | Key findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Akkoyun 2023 [24] | 2023 | USA | Retrospective cohort study | Children hospitalized for MIS-C | 138 | 9.9 (8.1–13.9) years | CDC criteria | 32 | IV anakinra was started at 8–10 mg/kg/day divided every 6 h in critically ill patients and 6–8 mg/kg/day divided every 6 h in non-critically ill patients | Anakinra use showed no differences in median duration of vasoactive support, fever resolution, CRP reduction, or Vasopressor-Inotrope Score |
| Chang 2023 [25] | 2023 | USA | Retrospective cohort study | MIS-C cases in a US surveillance registry | 1516 | 10.1 (4.1) years | CDC criteria | 121 | 4 mg/kg/day (range 0.2–20 mg/kg/day) | No short-term cardiovascular benefits observed with the early addition of anakinra to IVIG and glucocorticoids compared to using IVIG and glucocorticoids alone. |
| Dizon 2023 [26] | 2023 | USA | Observational clinical cohort study | Children hospitalized for MIS-C | 46 | 8 (4–10) years | CDC criteria | 32 | 8–10 mg/kg/day divided every 6 h in critically ill patients and 6–8 mg/kg/day divided every 6 h in non-critically ill patients | Anakinra treatment, primarily used alongside IVIG in patients with severe MIS-C, was linked to enhanced cardiac function and fever reduction |
| Dusser 2024 [27] | 2024 | France | Prospective study | Children Hospitalized for MIS-C | 470 | 10.06 (3.9) years | CDC criteria | 18 | 2.53 ± 1.3 mg/kg/day for a median duration of 3 days | Subcutaneous anakinra is a safe and effective option for treating heart failure or MAS in MIS-C. |
| Taddio 2024 [28] | 2024 | Italy | Retrospective cohort study | Children with MIS-C | 239 | 8 (I4–11) years | RCPCH criteria | 21 | NA | Early treatment with anakinra is both safe and highly effective in patients with severe MIS-C. |
| Yang 2023 [29] | 2023 | USA | Retrospective cohort study | Hospitalized pediatric patients (age ≤ 21 years) for MIS-C | 14 | 6 (4.0-10.5) years | NA | 14 | Initial median dose of 2.3 mg/kg with a median dosing interval of 12 h for a median initial treatment duration of 3.5 days | Clinicians should assess patient history and previous therapy responses before starting IV anakinra. Further extensive studies are needed to confirm its off-label safety and efficacy. |
Abbreviations: CDC: Centers for Disease Control and Prevention, CRP: C-reactive protein, IV: Intravenous, IVIG: Intravenous Immunoglobulin, IQR: Interquartile Range, MAS: Macrophage Activation Syndrome, MIS-C: Multisystem Inflammatory Syndrome in Children, RCPCH: Royal College of Paediatrics and Child Health, SD: Standard Deviation, VIS: Vasopressor-Inotrope Score