Early anakinra treatment may be beneficial for severe COVID-19
medwireNews: Preliminary findings from a US retrospective case series suggest that early treatment with the interleukin (IL)-1 receptor antagonist anakinra may be a promising strategy for COVID-19 patients with acute hypoxic respiratory failure (AHRF) and symptoms of cytokine storm syndrome (CSS).
Among 14 patients from New York who were hospitalized with confirmed SARS-CoV-2 infection between April and June 2020, 11 commenced treatment with subcutaneous anakinra at a dose of 100 mg every 6 hours, with a gradual increase in dosing interval to once every 24 hours, for a maximum of 19 days. Eight of the anakinra-treated patients also received background treatment with methylprednisolone, while those who did not receive anakinra were treated with an IL-6 inhibitor plus glucocorticoids.
Iris Navarro-Millán (Weill Cornell Medicine, New York) and co-authors report that the seven patients who received anakinra within 36 hours of AHRF onset either did not require mechanical ventilation (MV; n=6) or avoided recurrent MV (n=1) and were discharged home after 4–19 days of anakinra treatment.
The four patients who started anakinra at least 4 days after AHRF onset (late-initiation group) all required MV; three of these patients were extubated, with two discharged from hospital at the time of reporting, and one died. The study authors note that three patients in the late-initiation group developed infections, which led to discontinuation of the IL-1 inhibitor.
All of the three patients who were not treated with anakinra required MV. Of these patients, two were extubated (one discharged and one remained in hospital) and one continued to receive MV at the time of reporting.
“This case series suggests that anakinra confers the greatest benefit in COVID-19 with features of CSS when patients require high levels of supplemental O2 for <2 days and before intubation,” say the researchers, noting that “early aggressive treatment was likely key in improving the patients’ risk for requiring MV without major risk of complications.”
They add: “For patients requiring MV, anakinra should be used with caution due to risk of complications such as superimposed bacterial infection.”
And the team concludes in Arthritis & Rheumatology: “This phenotype and treatment approach should be considered for examination in ongoing and future clinical trials to determine the safety and efficacy of anakinra in patients with COVID-19 and features of CSS.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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