Anakinra and Intravenous IgG versus Tocilizumab in the Treatment of COVID-19 Pneumonia
| Autor: | S. Verga, Eduardo Dominguez Castillo, A.J. Gangemi, M. Zantah, Maulin Patel, Arthur Lau, Kevin Lu, Hauquing Zhao, Justin Levinson, Osheen Abramian, Mattew Zheng, Gerard J. Criner, J.M. Chowdhury, Roberto Caricchio |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Anakinra business.industry Incidence (epidemiology) medicine.medical_treatment medicine.disease medicine.disease_cause law.invention Pneumonia chemistry.chemical_compound Tocilizumab Randomized controlled trial chemistry law Internal medicine Superinfection Oxygen therapy medicine Cytokine storm business medicine.drug |
| DOI: | 10.1101/2020.09.11.20192401 |
| Popis: | BackgroundCOVID-19 can lead to acute respiratory failure and an exaggerated inflammatory response. Studies have suggested promising outcomes using monoclonal antibodies targeting IL-1β (Anakinra) or IL6 (Tocilizumab), however no head to head comparison was done between the two treatments. Herein, we report our experience in treating COVID-19 pneumonia associated with cytokine storm with either subcutaneous Anakinra given concomitantly with intravenous immunoglobulin (IVIG), or intravenous Tocilizumab.MethodsComprehensive clinical and laboratory data from patients with COVID-19 pneumonia admitted at our hospital between March and May 2020 were collected. Patients who received either Anakinra/ IVIG or Tocilizumab were selected. Baseline characteristics including oxygen therapy, respiratory status evaluation using ROX index, clinical assessment using NEWS score and laboratory data were collected. Outcomes included mortality, intubation, ICU admission and length of stay. In addition, we compared the change in ROX index, NEWS score and inflammatory markers at days 7 and 14 post initiation of therapy.Results84 consecutive patients who received either treatment (51 in the Anakinra/ IVIG group and 33 in the Tocilizumab group) were retrospectively studied. Baseline inflammatory markers were similar in both groups. There was no significant difference regarding to death (21.6% vs 15.2%, p 0.464), intubation (15.7% vs 24.2%, p 0.329), ICU need (57.1% vs 48.5%, p 0.475) or length of stay (13+9.6 vs 14.9+11.6, p 0.512) in the Anakinra/IVIG and Tocilizumab, respectively. Additionally, the rate of improvement in ROX index, NEWS score and inflammatory markers was similar in both groups at days 7 and 14. Furthermore, there was no difference in the incidence of superinfection in both groups.ConclusionTreating COVID-19 pneumonia associated with cytokine storm features with either subcutaneous Anakinra/IVIG or intravenous Tocilizumab is associated with improved clinical outcomes in most subjects. The choice of treatment does not appear to affect morbidity or mortality. Randomized controlled trials are needed to confirm our study findings.FundingNone. |
| Databáze: | OpenAIRE |
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