Abstract
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.
Keywords: Anakinra; COVID-19; Immunomodulation; Outcome; Therapy; Tocilizumab.
【저자키워드】 COVID-19, therapy, Anakinra, Tocilizumab, immunomodulation, outcome, 【초록키워드】 Treatment, severe COVID-19, Tocilizumab, Pneumonia, pulse oximetry, SARS-COV-2 infection, Comorbidities, oxygen, Cytokine release syndrome, COVID-19 disease, clinical status, oxygen saturation, Patient, Control, Clinical improvement, age, Follow-up, prospective cohort, Primary outcome, control group, in-hospital mortality rate, fraction, SpO2/FiO2, males, thought, selected, receiving, treated, determine, prognosis of patient, 1:1, baseline, cohort of patient, elapsed, initiation of treatment, patients with COVID-19, subgroup of patient, 【제목키워드】 retrospective,