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Effectiveness of anakinra for tocilizumab-refractory severe COVID-19: A single-centre retrospective comparative study

2021; Elsevier BV; Volume: 105; Linguagem: Inglês

10.1016/j.ijid.2021.02.041

1878-3511

Cristina de la Calle, Francisco López‐Medrano, José L. Pablos, Jaime Lora‐Tamayo, Guillermo Maestro de la Calle, Marcos Sánchez-Fernández, Mario Fernández‐Ruiz, María Asunción Pérez‐Jacoiste Asín, José Manuel Caro‐Teller, Rocío García-García, M. Catalán, Joaquín Martínez‐López, Ángel Sevillano, Julia Origüen, M. Ripoll, Rafael San Juan, Antonio Lalueza, Borja de Miguel, Octavio Carretero, Fernando Aguilar-Rodríguez, Carlos F. Gómez, Estela Paz‐Artal, Héctor Bueno, Carlos Lumbreras, José María Aguado,

Inflammasome and immune disorders

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.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.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).Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19.