Background and importance Anakinra is a recombinant interleukin 1 (IL-1) receptor antagonist and might help to neutralise the acute respiratory distress syndrome (ARDS) related to the SARS-CoV-2 hyperinflammatory state.
Aim and objectives To evaluate the use of anakinra in severe COVID-19 pneumonia previously treated with tocilizumab.
Material and methods A retrospective study in a general university hospital with 503 beds was conducted. Patients or relatives gave oral consent for the use of anakinra. Posology was 100 mg/12 hours on day 1 and 100 mg/24 hours on days 2–5, given subcutaneously. All received thromboembolic prophylaxis and were previously treated with hydroxychloroquine, azithromycin, corticosteroids and tocilizumab. Demographic variables, comorbidities, onset of symptoms and biochemical parameters (leucocytes, neutrophils, lymphocytes, platelets, haemoglobin, transaminases, LDH, creatinine, CRP, procalcitonin, CK, D-dimer, ferritin) at baseline and at discharge or death were recorded. The main outcome was mortality.
Results 17 patients were treated from 4 to 26 April. Median age was 69 years (IQR 12) and 11 (65%) were men. 15 (88%) patients had mechanical ventilation (MV). The main comorbidities were hypertension (8, 47%) and dyslipidaemia (11, 65%). 7 (41%) had two or more comorbidities. 11 patients (65%) were admitted after 7 or more days with symptoms, the median being 7.5 days (IQR 5.8). Median days of admission were 36 (IQR 35) and ICU admission was for 26.5 (IQR 35) days. Median days from the start of symptoms to treatment with anakinra was 18.5 days (IQR 6) and from the start of anakinra to discharge/death was 23 days (IQR 30.5). Baseline values of lymphocytes (0.6×109/L, IQR 0.4), AST (38 U/L, IQR 28.5), ALT (59 U/L, IQR 99), CRP (1.6 mg/dL, IQR 9.6), LDH (735 U/L, IQR 368), D-dimer (1350 ng/mL, IQR 1734) and ferritin (928 µg/L, IQR 1736) were altered. At discharge/death, only lymphocyte count had improved significantly (1.1×109/L, IQR 0.8, p=0.003). 10 patients (59%) died. Two patients did not finish treatment due to death, 3 due to elevated transaminases and 1 due to neutropenia.
Conclusion and relevance Mortality was high, but our population were critical patients with MV, ARDS and with a poor evolution despite having received other immunomodulatory treatments. Anakinra, like tocilizumab, must be used in earlier stages of the disease to reduce the inflammatory response. Delaying treatment does not provide benefits for patient cure.
Conflict of interest No conflict of interest
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