key: cord-0752471-z3rm525a
authors: Banday, Aaqib Zaffar; Vignesh, Pandiarajan
title: Use of tocilizumab in multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2
date: 2020-10-26
journal: J Pediatr
DOI: 10.1016/j.jpeds.2020.09.054
sha: 3109d399c7f27f6e0d2c16cec198f60d0f6b5f80
doc_id: 752471
cord_uid: z3rm525a

nan

Use of tocilizumab in multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2

To the Editor:

Kaushik et al provide a comprehensive overview of characteristics of the multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 All 33 children had evidence of SARS-CoV-2 infection in the form of positive reverse-transcription polymerase chain reaction and/or positive antibody test. 1 Similar to routine (non-SARS-CoV-2 related) Kawasaki disease, the most common treatment modality employed was intravenous immunoglobulin. Nearly one-half of the cohort received glucocorticoids; antiinterleukin (IL)-1 and anti-IL-6 agents were used in 12 and 4 patients, respectively. Tocilizumab was used in children with prominent coronary arteries on echocardiography but not in children with coronary artery ectasia. Large studies on MIS-C 2,3 mention the successful use of tocilizumab in controlling inflammation; however, data on the outcome of coronary artery abnormalities are lacking. Putative worsening of coronary artery aneurysms is a significant concern in children with Kawasaki disease treated with tocilizumab. 4 Tocilizumab has been used to mitigate the cytokine storm associated with SARS-CoV-2, both in children as well as adults 5, 6 ; however, levels of IL-6 seem to be lower in MIS-C as compared with severe SARS-CoV-2 infection in adults. 7 If the authors could provide additional follow-up data of coronary artery abnormalities in patients in whom tocilizumab was used, this could serve as baseline evidence for the efficacy of anti-IL-6 agents in MIS-C concerning coronary artery outcomes. We envisage tocilizumab to be used more often in children with intravenous immunoglobulin-refractory MIS-C in India, as anti-IL-1 agents are not available in commercial markets. 

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