Colleen Cloyd, PharmD, BCPPS
Advanced Patient Care Pharmacist
Nationwide Children's Hospital
Columbus, Ohio
Disclosure information not submitted.
Cheryl Sargel, PharmD, BCCCP
Dr.
Nationwide Children's Hospital, United States
Disclosure information not submitted.
Title: Anakinra Dosing for Macrophage Activation Syndrome during Continuous Renal Replacement Therapy
Introduction: Secondary hematophagocystic lymphohistocytosis (sHLH) and macrophage activating syndrome (MAS) are associated with increased morbidity and mortality in the pediatric intensive care unit. Renal impairment and the use of continuous renal replacement therapy (CRRT) may be present, and treatment with anakinra can be recommended for refractory cases. Optimal dosing for this indication, particularly in the case of organ dysfunction and concomitant CRRT, have yet to be established.
Methods: A query of the medical record system was performed for all patients who received anakinra for the treatment of sHLH/MAS and concomitant CRRT between 2013 and 2021. Laboratory parameters, clinical information, and anakinra dosing histories were collected surrounding the diagnosis and management of sHLH/MAS. Dosing of anakinra was adjusted per provider preference.
Results: Five patients aged 11-18 years received intravenous anakinra and CRRT. All patients received high flow continuous veno-venous hemodiafiltration (CVVHDF) and concomitant intravenous steroids during anakinra therapy. Two patients were started on anakinra dosing of 100mg IV every 6 hours, two patients were started on anakinra 100mg IV every 12 hours and one patient was initiated on anakinra 100mg IV every 8 hours. The average starting dosing of anakinra was 5.9 mg/kg/day. All patients required dosing of anakinra 100mg every 6 hours (average of 7.5 mg/kg/day) for improvement of laboratory parameters and clinical symptoms while on CVVHDF. No patients experienced neutropenia and one patient demonstrated a new nosocomial infection while on anakinra therapy.
Conclusions: We describe anakinra dosing for sHLH/MAS for pediatric patients receiving concomitant CVVHDF. All patients required anakinra 100mg IV every 6 hours to demonstrate a laboratory response during the course of treatment while on CVVHDF. Further, larger studies examining this relationship to dose and resolutions of sHLH/MAS in pediatric patients is warranted.