Severe COVID-19 in pediatric age: an update on the role of the anti-rheumatic agents.
Pediatr Rheumatol Online J
; 19(1): 68, 2021 May 04.
Article
in English
| MEDLINE | ID: covidwho-1216904
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Biological Factors
/
Systemic Inflammatory Response Syndrome
/
Antirheumatic Agents
/
COVID-19
/
COVID-19 Drug Treatment
Type of study:
Prognostic study
Topics:
Long Covid
Limits:
Child
/
Humans
Language:
English
Journal:
Pediatr Rheumatol Online J
Year:
2021
Document Type:
Article
Affiliation country:
S12969-021-00559-5
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