Around the tenth day after diagnosis, ∼20% of patients with coronavirus disease 2019 (COVID-19)−associated pneumonia evolve toward severe oxygen dependence (stage 2b) and acute respiratory distress syndrome (stage 3) associated with systemic inflammation often termed a “cytokine storm.” Because interleukin-1 (IL-1) blocks the production of IL-6 and other proinflammatory cytokines, we treated COVID-19 patients early in the disease with the IL-1 receptor antagonist, anakinra. We retrospectively compared 22 patients from three different centers in France with stages 2b and 3 COVID-19−associated pneumonia presenting with acute severe respiratory failure and systemic inflammation who received either standard-of-care treatment alone (10 patients) or combined with intravenous anakinra (12 patients). Treatment started at 300 mg⋅d −1 for 5 d, then tapered with lower dosing over 3 d. Both populations were comparable for age, comorbidities, clinical stage, and elevated biomarkers of systemic inflammation. All of the patients treated with anakinra improved clinically ( P < 0.01), with no deaths, significant decreases in oxygen requirements ( P < 0.05), and more days without invasive mechanical ventilation ( P < 0.06), compared with the control group. The effect of anakinra was rapid, as judged by significant decrease of fever and C-reactive protein at day 3. A mean total dose of 1,950 mg was infused with no adverse side effects or bacterial infection. We conclude that early blockade of the IL-1 receptor is therapeutic in acute hyperinflammatory respiratory failure in COVID-19 patients.
【저자키워드】 COVID-19, Anakinra, Pneumonia, interleukin-1, 【초록키워드】 Treatment, coronavirus disease, Biomarker, Respiratory failure, IL-6, severe respiratory failure, Comorbidities, Diagnosis, C-reactive protein, oxygen, Population, Fever, therapeutic, Patient, France, Bacterial infection, age, systemic inflammation, receptor, proinflammatory cytokines, patients, IL-1, COVID-19 patients, acute respiratory distress, Invasive mechanical ventilation, dose, deaths, COVID-19 patient, intravenous, Side effect, control group, syndrome, Stage, significant decrease, blockade, Oxygen requirement, IL-1 receptor antagonist, Standard-of-care, block, Hyperinflammatory, the patient, clinically, the disease, elevated, treated, comparable, presenting, infused, 【제목키워드】 Respiratory failure, receptor, IL-1, Inflammatory, blockade,