Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents
Open Access
- 4 May 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Pediatric Rheumatology
- Vol. 19 (1), 1-11
- https://doi.org/10.1186/s12969-021-00559-5
Abstract
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. 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. 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.Keywords
This publication has 103 references indexed in Scilit:
- Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator TherapyInternational Journal of Molecular Sciences, 2017
- Weathering the Storm: Improving Therapeutic Interventions for Cytokine Storm Syndromes by Targeting Disease PathogenesisCurrent Treatment Options in Rheumatology, 2017
- Early changes in gene expression and inflammatory proteins in systemic juvenile idiopathic arthritis patients on canakinumab therapyArthritis Research & Therapy, 2017
- Emerging pathogenic links between microbiota and the gut–lung axisNature Reviews Microbiology, 2016
- 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic ArthritisAnnals Of The Rheumatic Diseases, 2016
- Interleukin-1 Receptor Blockade Is Associated With Reduced Mortality in Sepsis Patients With Features of Macrophage Activation SyndromeCritical Care Medicine, 2016
- A Common Immunopathogenesis Mechanism for Infectious Diseases: The Protein-Homeostasis-System HypothesisInfection & Chemotherapy, 2015
- AAK1 Regulates Numb Function at an Early Step in Clathrin‐Mediated EndocytosisTraffic, 2008
- Up-regulation of IL-6 and TNF-α induced by SARS-coronavirus spike protein in murine macrophages via NF-κB pathwayVirus Research, 2007
- The antiinflammatory activity of IgG: the intravenous IgG paradoxThe Journal of Experimental Medicine, 2007