From the Research
Maraviroc (Selzentry) is not currently recommended as an adjunct treatment for Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). While there is ongoing research exploring various immunomodulatory approaches for PANS, Maraviroc specifically lacks sufficient clinical evidence to support its use in this condition. The most recent and highest quality study, 1, a systematic review published in 2021, reveals very low certainty of evidence of beneficial effects, and moderate certainty of evidence of adverse effects, of anti-inflammatory, antibacterial or immunomodulating treatments in patients with symptoms corresponding to the research condition PANS. Maraviroc is an FDA-approved CCR5 antagonist primarily used in HIV treatment, and its mechanism of action in blocking certain immune cell receptors has generated theoretical interest for autoimmune conditions. However, standard PANS treatment typically involves antibiotics if infection is present, anti-inflammatory medications, immunomodulatory therapies like IVIG in severe cases, and psychiatric medications to manage symptoms.
The potential risks of Maraviroc, including liver toxicity, infections, and cardiovascular effects, outweigh any theoretical benefits given the absence of clinical trial data in PANS patients. Other studies, such as 2 and 3, provide guidance on the treatment of PANS, but do not support the use of Maraviroc. Additionally, studies like 4 and 5 demonstrate the lack of efficacy of Maraviroc in other conditions, further supporting the decision not to recommend its use in PANS. Families seeking treatment for PANS should work with specialists experienced in this condition to develop evidence-based treatment plans that may include antibiotics, anti-inflammatory medications, and behavioral interventions rather than pursuing experimental treatments without sufficient safety and efficacy data.
Some key points to consider when treating PANS include:
- The use of antibiotics if infection is present
- The use of anti-inflammatory medications
- The use of immunomodulatory therapies like IVIG in severe cases
- The use of psychiatric medications to manage symptoms
- The importance of working with specialists experienced in PANS to develop evidence-based treatment plans.