Effectiveness of anakinra for tocilizumab-refractory severe COVID-19: A single-centre retrospective comparative study. (April 2021)

• Record Type: Journal Article
• Authors: de la Calle, Cristina; López-Medrano, Francisco; Pablos, José Luis; Lora-Tamayo, Jaime; Maestro-de la Calle, Guillermo; Sánchez-Fernández, Marcos; Fernández-Ruiz, Mario; Pérez-Jacoiste Asín, María Asunción; Caro-Teller, José Manuel; García-García, Rocío; Catalán, Mercedes; Martínez-López, Joaquín; Sevillano, Ángel; Origüen, Julia; Ripoll, Mar; San Juan, Rafael; Lalueza, Antonio; de Miguel, Borja; Carretero, Octavio; Aguilar, Fernando; Gómez, Carlos; Paz-Artal, Estela; Bueno, Héctor; Lumbreras, Carlos; Aguado, José María
• Is Part Of: International journal of infectious diseases. Volume 105(2021)
• Page Start: 319
• Page End: 325
• Publication Date: 2021-04
• Subjects: COVID-19 -- Anakinra -- Tocilizumab -- Therapy -- Immunomodulation -- Outcome; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.02.041
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Immunomodulatory treatment could improve the prognosis of COVID-19. Patients who received anakinra as rescue therapy were compared with controls. Anakinra did not improve in-hospital prognosis of patients after tocilizumab failure. Abstract: Objectives: A subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease. Methods: A prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline, and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a 6-point ordinal scale, from baseline to day 21. Results: The study included 20 cases and 20 controls (mean age 65.3 ± 12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527). Conclusions: Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19.