{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:36:31Z","timestamp":1794242191880,"version":"4.9.0"},"reference-count":40,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23\u2010HL\u2010148539"],"award-info":[{"award-number":["K23\u2010HL\u2010148539"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R61\u2010HD\u2010105593"],"award-info":[{"award-number":["R61\u2010HD\u2010105593"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Evidence regarding effectiveness of interleukin\u20101 receptor antagonism in multisystem inflammatory syndrome in children (MIS\u2010C) is lacking. We characterized variation in initial treatment with anakinra and evaluated cardiovascular outcomes associated with adding anakinra to standard initial therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of MIS\u2010C 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\u20131) were identified. We compared cases in patients ages 2\u201320\u2009years receiving intravenous immunoglobulin (IVIG) and glucocorticoids versus anakinra plus IVIG and\/or glucocorticoids on days 0\u20131, 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\u20134. The secondary outcome was 50% reduction in C\u2010reactive protein on day 3.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1,516 MIS\u2010C cases at 44 sites, 193 (13%) patients received anakinra alone or with other immunomodulators as initial treatment (range 0\u201374% 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\u00a0=\u00a0121) versus IVIG plus glucocorticoids (n\u00a0=\u00a0389) 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\u20131.84]), ventricular dysfunction (33.7% versus 25.7%, respectively; RR 1.31 [95% CI 0.98\u20131.75]), or C\u2010reactive protein reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We identified substantial variation in initial anakinra use in a real\u2010world population of children with MIS\u2010C, but no average short\u2010term improvement in cardiovascular outcomes associated with early addition of anakinra to IVIG and\/or glucocorticoids compared to IVIG and glucocorticoids alone.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42495","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T01:19:07Z","timestamp":1678670347000},"page":"1466-1476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Variation in Early Anakinra Use and <scp>Short\u2010Term<\/scp> Outcomes in Multisystem Inflammatory Syndrome in Children"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1691-4814","authenticated-orcid":false,"given":"Joyce C.","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Immunology, Boston Children's Hospital, and Department of Pediatrics Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron C.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Muscal","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Pediatrics Baylor College of Medicine  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Sexson Tejtel","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics Baylor College of Medicine and Texas Children's Fetal Center  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret M.","family":"Newhams","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suden","family":"Kucukak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain 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B.","family":"Halasa","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics Vanderbilt University Medical Center  Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen A.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Rady Children's Hospital\u2013San Diego  San Diego California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte V.","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Pediatrics University of Mississippi Medical Center  Jackson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Pediatrics Nationwide Children's Hospital  Columbus 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Philadelphia, University of Pennsylvania Perelman School of Medicine  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aalok R.","family":"Singh","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Division Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College  Valhalla New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Wellnitz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics University of Iowa Carver College of Medicine  Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan A.","family":"Nofziger","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine Akron Children's Hospital  Akron Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie Z.","family":"Cvijanovich","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine UCSF Benioff Children's Hospital Oakland  Oakland California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth H.","family":"Mack","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine Medical University of South Carolina  Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J.","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine Children's Hospital Orange County  Orange California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina M.","family":"Heidemann","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine Children's Hospital of Michigan, Central Michigan University  Detroit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane W.","family":"Newburger","sequence":"additional","affiliation":[{"name":"Department of Cardiology Boston Children's 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