Effectiveness Of Anakinra Therapy On Covid-19 Patients In Icu

Year 2023, , 7 - 12, 31.01.2023

Elmas Uysal , Işıl Özkoçak Turan , Handan Ankaralı

https://doi.org/10.47482/acmr.1129700

Abstract

Background: There is no consensus on effective treatments for COVID-19 disease yet. Our aim; To observe the clinical and laboratory results of anakinra treatment on intensive care patients and to contribute to the literature on its usefulness.
Material and Methods: The characteristics of the patients receiving Anakinra treatment in the COVID ICU of xx were retrospectively reviewed. The patients' ages, gender, mechanical ventilation (MV) duration, length of stay in the intensive care unit, CRP, procalcitonin, LDH, IL-6, lymphocyte, Dv dimer, ferritin values and the corticosteroid doses they received in addition to Anakinra treatment were also evaluated. In addition, the data of the patient group who did not receive Anakinra but received high-dose (≥250 mg) methylprednisolone (MPZ) treatment were compared with the present patient data and evaluated in terms of treatment effectiveness.
Results: When the patients that receiving Anakinra+high-dose MPZ are compared with the patient group receiving only high-dose MPZ,it was seen that the mortality rate is significantly higher (P=0.038), MV and hospitalization days in the intensive care unit were significantly longer in patients receiving Anakinra (p=0.001, p=0.004). However, there was no significant difference in secondary reproduction rates between the two groups (P=0.484). As the mean hospitalization days of the group receiving Anakinra + high-dose MPZ and the group receiving Anakinra + low-dose (<250mg) MPZ were found to be significantly longer in the group receiving Anakinra + high-dose steroids (p=0.018), there was no significant difference in terms of MV time and mortality rates (p=0.193, p=1.0).
Conclusion: In our study, the patients who received Anakinra treatment had a longer hospitalization day and MV period, and the higher mortality rate was attributed to this patient group who had a more severe course. It was observed that the use of anakinra treatment after low-dose and high-dose MPZ treatment did not cause a significant difference in mortality rates. However, due to the small number of patients and the heterogeneity of the patient group, more comprehensive and randomized studies are needed.

Keywords

Anakinra treatment, COVID-19 disease, cytokine storm

References

• 1.Jamilloux Y, Henry T, Belot A, et al. Should we stimulate or supress ımmune responses in COVID-19? Cytokine and ant-cytokine interventions. Autoımmun Rev. 2020;19(7):102567.
• 2. Lucas M. Kimmig, David Wu, Matthew Gold, et al. IL-6 Inhibition in Critically Ill COVID-19 Patients Is Associated With Increased Secondary Infections. Front. Med., 28 October 2020.
• 3.Kooistra EJ, Waalders NJB,Grndman I, et al. Anakinra treatment in critically ill COVID-19 patients:a prosprective cohort study. Crit care. 2020;24(1):688. Published 2020 Dec 10.
• 4. Cavalli G, De Luca G, Campochiaro C, et al.Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020 Jun;2(6):e325-e331.
• 5. González-García A, García-Sánchez I, Lopes V, Moreno-Arrones OM, Tortosa-Cabañas M, Elías-Sáenz I, Hernández-Rodríguez J. Successful treatment of severe COVID-19 with subcutaneous anakinra as a sole treatment. Rheumatology (Oxford). 2020 Aug 1;59(8):2171-2173.
• 6. Aouba A, Baldolli A, Geffray L, et al. Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series. Ann Rheum Dis. 2020 Oct;79(10):1381-1382.
• 7. Bozzi G, Mangioni D, Minoia F, et al. Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study. J Allergy Clin Immunol. 2021 Feb;147(2):561-566.e4.
• 8. Huet T, Beaussier H, Voisin O, Jouveshomme S, Dauriat G, Lazareth I, Sacco E, Naccache JM, Bézie Y, Laplanche S, Le Berre A, Le Pavec J, Salmeron S, Emmerich J, Mourad JJ, Chatellier G, Hayem G. Anakinra for severe forms of COVID-19: a cohort study. Lancet Rheumatol. 2020 Jul;2(7):e393-e400.
• 9. Kyriazopoulou, Evdoxia et al. “Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial.” Nature medicine vol. 27,10 (2021): 1752-1760.
• 10. Kyriazopoulou, Evdoxia et al. “An open label trial of anakinra to prevent respiratory failure in COVID-19.” eLife vol. 10 e66125. 8 Mar. 2021.
• 11. Pontali E, Volpi S, Signori A, et al. Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia. J Allergy Clin Immunol. 2021;147(4):1217-1225.
• 12. Kyriakoulis KG, Kollias A, Poulakou G, et al. The Effect of Anakinra in Hospitalized Patients with COVID-19: An Updated Systematic Review and Meta-Analysis. J Clin Med. 2021;10(19):4462. Published 2021 Sep 28.