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

Autor: Ismael Francisco Aomar-Millán, Juan Salvatierra, Úrsula Torres-Parejo, Naya Faro-Miguez, José Luis Callejas-Rubio, Ángel Ceballos-Torres, María Teresa Cruces-Moreno, Francisco Javier Gómez-Jiménez, José Hernández-Quero, Francisco Anguita-Santos
Rok vydání: 2021
Předmět:
musculoskeletal diseases
Male
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Ce - Letter to the Editor
MEDLINE
Hyperinflammation
030204 cardiovascular system & hematology
Antibodies
Monoclonal
Humanized
Methylprednisolone
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Tocilizumab
Internal medicine
Internal Medicine
medicine
Humans
In patient
030212 general & internal medicine
Glucocorticoids
Aged
Retrospective Studies
Aged
80 and over
Anakinra
business.industry
COVID-19
Retrospective cohort study
Middle Aged
medicine.disease
Im - Original
COVID-19 Drug Treatment
Survival Rate
Interleukin 1 Receptor Antagonist Protein
Pneumonia
Cytokine storm syndrome
Treatment Outcome
chemistry
Spain
Antirheumatic Agents
Emergency Medicine
Drug Therapy
Combination
Female
business
After treatment
medicine.drug
Zdroj: Internal and Emergency Medicine
ISSN: 1970-9366
1828-0447
DOI: 10.1007/s11739-021-02663-6
Popis: 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.
Databáze: OpenAIRE
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