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Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists
Data on therapy of COVID-19 in immunocompetent and immunosuppressed children are scarce. We aimed to explore management strategies of pediatric rheumatologists. All subscribers to international Pediatric Rheumatology Bulletin Board were invited to take part in an online survey on therapeutic approac...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938886/ https://www.ncbi.nlm.nih.gov/pubmed/33683393 http://dx.doi.org/10.1007/s00296-021-04824-4 |
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author | Janda, Ales Schuetz, Catharina Canna, Scott Gorelik, Mark Heeg, Maximilian Minden, Kirsten Hinze, Claas Schulz, Ansgar Debatin, Klaus-Michael Hedrich, Christian M. Speth, Fabian |
author_facet | Janda, Ales Schuetz, Catharina Canna, Scott Gorelik, Mark Heeg, Maximilian Minden, Kirsten Hinze, Claas Schulz, Ansgar Debatin, Klaus-Michael Hedrich, Christian M. Speth, Fabian |
author_sort | Janda, Ales |
collection | PubMed |
description | Data on therapy of COVID-19 in immunocompetent and immunosuppressed children are scarce. We aimed to explore management strategies of pediatric rheumatologists. All subscribers to international Pediatric Rheumatology Bulletin Board were invited to take part in an online survey on therapeutic approaches to COVID-19 in healthy children and children with autoimmune/inflammatory diseases (AID). Off-label therapies would be considered by 90.3% of the 93 participating respondents. In stable patients with COVID-19 on oxygen supply (stage I), use of remdesivir (48.3%), azithromycin (26.6%), oral corticosteroids (25.4%) and/or hydroxychloroquine (21.9%) would be recommended. In case of early signs of “cytokine storm” (stage II) or in critically ill patients (stage III) (a) anakinra (79.5% stage II; 83.6% stage III) or tocilizumab (58.0% and 87.0%, respectively); (b) corticosteroids (oral 67.2% stage II, intravenously 81.7% stage III); (c) intravenous immunoglobulins (both stages 56.5%); or (d) remdesivir (both stages 46.7%) were considered. In AID, > 94.2% of the respondents would not support a preventive adaptation of the immunomodulating therapy. In case of mild COVID-19, more than 50% of the respondents would continue pre-existing treatment with immunoglobulins (100%), hydroxychloroquine (94.2%), anakinra (79.2%) or canakinumab (72.5%), or tocilizumab (69.8%). Long-term corticosteroids would be reduced by 26.9% (< = 2 mg/kg/d) and 50.0% (> 2 mg/kg/day), respectively, with only 5.8% of respondents voting to discontinue the therapy. Conversely, more than 75% of respondents would refrain from administering cyclophosphamide and anti-CD20-antibodies. As evidence on management of pediatric COVID-19 is incomplete, continuous and critical expert opinion and knowledge exchange is helpful. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00296-021-04824-4. |
format | Online Article Text |
id | pubmed-7938886 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-79388862021-03-09 Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists Janda, Ales Schuetz, Catharina Canna, Scott Gorelik, Mark Heeg, Maximilian Minden, Kirsten Hinze, Claas Schulz, Ansgar Debatin, Klaus-Michael Hedrich, Christian M. Speth, Fabian Rheumatol Int Observational Research Data on therapy of COVID-19 in immunocompetent and immunosuppressed children are scarce. We aimed to explore management strategies of pediatric rheumatologists. All subscribers to international Pediatric Rheumatology Bulletin Board were invited to take part in an online survey on therapeutic approaches to COVID-19 in healthy children and children with autoimmune/inflammatory diseases (AID). Off-label therapies would be considered by 90.3% of the 93 participating respondents. In stable patients with COVID-19 on oxygen supply (stage I), use of remdesivir (48.3%), azithromycin (26.6%), oral corticosteroids (25.4%) and/or hydroxychloroquine (21.9%) would be recommended. In case of early signs of “cytokine storm” (stage II) or in critically ill patients (stage III) (a) anakinra (79.5% stage II; 83.6% stage III) or tocilizumab (58.0% and 87.0%, respectively); (b) corticosteroids (oral 67.2% stage II, intravenously 81.7% stage III); (c) intravenous immunoglobulins (both stages 56.5%); or (d) remdesivir (both stages 46.7%) were considered. In AID, > 94.2% of the respondents would not support a preventive adaptation of the immunomodulating therapy. In case of mild COVID-19, more than 50% of the respondents would continue pre-existing treatment with immunoglobulins (100%), hydroxychloroquine (94.2%), anakinra (79.2%) or canakinumab (72.5%), or tocilizumab (69.8%). Long-term corticosteroids would be reduced by 26.9% (< = 2 mg/kg/d) and 50.0% (> 2 mg/kg/day), respectively, with only 5.8% of respondents voting to discontinue the therapy. Conversely, more than 75% of respondents would refrain from administering cyclophosphamide and anti-CD20-antibodies. As evidence on management of pediatric COVID-19 is incomplete, continuous and critical expert opinion and knowledge exchange is helpful. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00296-021-04824-4. Springer Berlin Heidelberg 2021-03-08 2021 /pmc/articles/PMC7938886/ /pubmed/33683393 http://dx.doi.org/10.1007/s00296-021-04824-4 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Observational Research Janda, Ales Schuetz, Catharina Canna, Scott Gorelik, Mark Heeg, Maximilian Minden, Kirsten Hinze, Claas Schulz, Ansgar Debatin, Klaus-Michael Hedrich, Christian M. Speth, Fabian Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title | Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title_full | Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title_fullStr | Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title_full_unstemmed | Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title_short | Therapeutic approaches to pediatric COVID-19: an online survey of pediatric rheumatologists |
title_sort | therapeutic approaches to pediatric covid-19: an online survey of pediatric rheumatologists |
topic | Observational Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938886/ https://www.ncbi.nlm.nih.gov/pubmed/33683393 http://dx.doi.org/10.1007/s00296-021-04824-4 |
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