Rationale for use for monoclonal antibody therapy in multisystem inflammatory syndrome in children: a systematic review

Abstract

Objective To review systematically the rationale for choice and use of monoclonal antibody therapy in multisystem inflammatory syndrome in children (MIS-C). Study design A systematic review was conducted using electronic databases (MEDLINE, Embase, Global Health, SCOPUS, and Web of Science) and preprint servers (MedRxiv and BioRxiv) between 01/01/2020 and 01/03/22. Studies were included if they had pediatric patients aged <21 years with MIS-C that had experienced the use of monoclonal antibodies. Randomized controlled trials, cohort studies, case reports, case series, case-control studies, and cohort studies were included. Results Twenty observational studies with 726 patients were included. Anakinra, tocilizumab and infliximab were used in 9.9%, 6.9%, and 12.4% of the cases, respectively. The most common rationale for the initiation of monoclonal antibody therapy for MIS-C was for patients who presented with severe disease or refractory to first line therapy. Infliximab tended to be used because of its precedence in managing IVIG-resistant Kawasaki Disease. Conclusions Use and choice of Monoclonal antibody seems to rely more on subjective clinician preferences than rigorous evidence-based studies. More studies exploring the exact pathogenesis of MIS-C are warranted to identify the key players of the cytokine storm that act as biological targets and their outcomes.