Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study

• Published in: Internal and emergency medicine Vol. 16; no. 4; pp. 843 - 852
• Main Authors: Aomar-Millán, Ismael Francisco, Salvatierra, Juan, Torres-Parejo, Úrsula, Faro-Miguez, Naya, Callejas-Rubio, José Luis, Ceballos-Torres, Ángel, Cruces-Moreno, María Teresa, Gómez-Jiménez, Francisco Javier, Hernández-Quero, José, Anguita-Santos, Francisco
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2021; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - administration & dosage; Antirheumatic Agents - administration & dosage; CD4 antigen; Cohort analysis; Coronaviruses; Corticosteroids; COVID-19; COVID-19 - complications; COVID-19 - drug therapy; COVID-19 - mortality; COVID-19 : diagnosis; Drug Therapy, Combination; Female; Glucocorticoids - administration & dosage; Humans; Im - Original; Immunosuppressive agents; Interleukin 1; Interleukin 1 receptor antagonist; Interleukin 1 Receptor Antagonist Protein - administration & dosage; Internal Medicine; Male; management and prognosis; Medicine; Medicine & Public Health; Methylprednisolone; Methylprednisolone - administration & dosage; Middle Aged; Monoclonal antibodies; Patients; Pneumonia; Retrospective Studies; Spain; Survival Rate; Treatment Outcome; Spain; COVID-19; Hyperinflammation; Cytokine storm syndrome; Methylprednisolone; Tocilizumab; Anakinra
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-020-02600-z

Introduction Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. Patients and Methods A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. Results 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265–0.910; p  = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. Conclusions In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.