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Pediatric Rheumatology

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Open Access 01-12-2021 | Anakinra | Review

Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents

Authors: Giorgio Costagliola, Erika Spada, Rita Consolini

Published in: Pediatric Rheumatology | Issue 1/2021

Abstract

Background

SARS-CoV-2 can induce an immune impairment and dysregulation, finally resulting in the massive release of inflammatory mediators (cytokine storm), strongly contributing to the pulmonary and systemic manifestations in severe coronavirus disease 2019 (COVID-19). As a consequence, different drugs active on the immune system have been proposed for the treatment of the disease in adults.

Role of the anti-rheumatic agents in children

Children are more likely to develop a mild disease course, as the severe form of COVID-19 is identified in less than 5% of the pediatric patients. Moreover, in children a peculiar disease phenotype, defined as multisystem inflammatory syndrome in children (MIS-C) is observed, representing the most severe expression of the inflammatory dysregulation caused by SARS-CoV-2. The limited experience with the severe pediatric COVID-19 and MIS-C does not allow conclusions about the role of the immune pharmacological approach, and therefore the treatment of these conditions represents a considerable clinical challenge. The use of chloroquine, hydroxychloroquine, and colchicine in the early disease stages is not sufficiently supported by evidence, and there is an increasing interest in the role of biologic agents, including anti-IL-1 and anti-IL-6 agents, in the prevention and treatment of the severe manifestations of COVID-19.

Conclusion

The therapeutic approach to pediatric COVID-19 is multidisciplinary, and anti-rheumatic agents have a prominent role in severe disease. This paper reviews the rationale for the use of anti-rheumatic agents in pediatric COVID-19 and MIS-C and the clinical experience with the single drugs. Finally, the areas of potential improvement in the use of anti-rheumatic agents, including the optimization of the drug choice and the timing of administration, are discussed.

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Title: Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents
Authors: Giorgio Costagliola
Erika Spada
Rita Consolini
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Anakinra
Tocilizumab
SARS-CoV-2
Acute Respiratory Distress-Syndrome
COVID-19
Cytokines
Coronavirus
Published in: Pediatric Rheumatology / Issue 1/2021
Electronic ISSN: 1546-0096
DOI: https://doi.org/10.1186/s12969-021-00559-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents

Abstract

Background

Role of the anti-rheumatic agents in children

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Role of the anti-rheumatic agents in children

Conclusion

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