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

Abstract

Objetives A subgroup of patients with SARS-CoV-2 infection is considered to develop a cytokine release syndrome and have been treated with tocilizumab, but a significant percentage of patients evolve. Our objective was to determine the usefulness of anakinra as rescue treatment for patients with tocilizumab-refractory COVID-19 disease. Methods A prospective cohort of patients with COVID19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) to 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 six-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. 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 to improve the prognosis of patients with tocilizumab-refractory severe COVID-19.

Predictors of poor outcome in tocilizumab treated patients with Sars-CoV-2 related severe respiratory failure: A multicentre real world study

“…Which is the optimal pharmacological strategy in patients refractory to Tocilizumab is an unresolved issue. A small sample size study showed no advantage of the IL-1 antagonist Anakinra as rescue treatment in Tocilizumab-refractary patients [38] .…”

The Emerging Role of Neutrophils in the Pathogenesis of Thrombosis in COVID-19

“…On the other hand, the CORIMUNO-ANA-1 study reported that Anakinra did not improve outcomes in patients with mild-to-moderate COVID-19 pneumonia [97]. Similarly, a single-center retrospective comparative study was performed by de la Calle et al, which reported that treatment with anakinra was not able to improve the prognosis of patients with tocilizumab-refractory severe COVID-19 [98].…”

Anakinra or tocilizumab for prevention of COVID-19 death? A big dilemma

“…In the absence of an effective treatment option against COVID-19, the steadily increased mortality among infected subjects and the delay in the widespread vaccination of the general population, it seems that immunomodulatory agents might be crucial for the management of the disease. However, it remains unclear which one should be preferred, although they could be administered sequentially in refractory cases [3,4].…”