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Comparative Study
. 2021 Apr:105:319-325.
doi: 10.1016/j.ijid.2021.02.041. Epub 2021 Feb 13.

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

Cristina de la Calle  1 , Francisco López-Medrano  2 , José Luis Pablos  3 , Jaime Lora-Tamayo  1 , Guillermo Maestro-de la Calle  1 , Marcos Sánchez-Fernández  1 , Mario Fernández-Ruiz  4 , María Asunción Pérez-Jacoiste Asín  1 , José Manuel Caro-Teller  5 , Rocío García-García  6 , Mercedes Catalán  7 , Joaquín Martínez-López  8 , Ángel Sevillano  9 , Julia Origüen  10 , Mar Ripoll  1 , Rafael San Juan  11 , Antonio Lalueza  1 , Borja de Miguel  1 , Octavio Carretero  4 , Fernando Aguilar  1 , Carlos Gómez  12 , Estela Paz-Artal  13 , Héctor Bueno  14 , Carlos Lumbreras  15 , José María Aguado  11
Affiliations
Comparative Study

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

Cristina de la Calle et al. Int J Infect Dis. 2021 Apr.

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.

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Figures

Figure 1
Figure 1
Patient status according to the 6-point ordinal scale during the follow-up. The first bar of each day indicates the clinical situation of the cases and the second bar that of the controls.
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