International Journal of Infectious Diseases (Apr 2021)

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

  • Cristina de la Calle,
  • Francisco López-Medrano,
  • José Luis 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,
  • Mercedes Catalán,
  • Joaquín Martínez-López,
  • Ángel Sevillano,
  • Julia Origüen,
  • Mar Ripoll,
  • Rafael San Juan,
  • Antonio Lalueza,
  • Borja de Miguel,
  • Octavio Carretero,
  • Fernando Aguilar,
  • Carlos Gómez,
  • Estela Paz-Artal,
  • Héctor Bueno,
  • Carlos Lumbreras,
  • José María Aguado

Journal volume & issue
Vol. 105
pp. 319 – 325

Abstract

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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.

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