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Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab

OBJECTIVE: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). METHODS: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or ana...

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Autores principales: Langer-Gould, Annette, Smith, Jessica B., Gonzales, Edlin G., Castillo, Rhina D., Figueroa, Judith Garza, Ramanathan, Anusha, Li, Bonnie H., Gould, Michael K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Southern California Permanente Medical Group. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406519/
https://www.ncbi.nlm.nih.gov/pubmed/32768693
http://dx.doi.org/10.1016/j.ijid.2020.07.081
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author Langer-Gould, Annette
Smith, Jessica B.
Gonzales, Edlin G.
Castillo, Rhina D.
Figueroa, Judith Garza
Ramanathan, Anusha
Li, Bonnie H.
Gould, Michael K.
author_facet Langer-Gould, Annette
Smith, Jessica B.
Gonzales, Edlin G.
Castillo, Rhina D.
Figueroa, Judith Garza
Ramanathan, Anusha
Li, Bonnie H.
Gould, Michael K.
author_sort Langer-Gould, Annette
collection PubMed
description OBJECTIVE: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). METHODS: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from electronic health records. RESULTS: At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only seven (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated). Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) compared to those extubated/never intubated (median = 1 day). After accounting for differences in disease severity at treatment initiation, this apparent superiority of anakinra over tocilizumab was no longer statistically significant (propensity score-adjusted hazards ratio 0.46, 95% confidence interval 0.18–1.20). CONCLUSIONS: Prompt identification and treatment of COVID19-CS before intubation may be more important than the specific type of anti-inflammatory treatment. Randomized controlled trials of targeted anti-cytokine treatments and corticosteroids should report the duration of cytokine storm in addition to clinical severity at randomization.
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spelling pubmed-74065192020-08-06 Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab Langer-Gould, Annette Smith, Jessica B. Gonzales, Edlin G. Castillo, Rhina D. Figueroa, Judith Garza Ramanathan, Anusha Li, Bonnie H. Gould, Michael K. Int J Infect Dis Article OBJECTIVE: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). METHODS: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from electronic health records. RESULTS: At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only seven (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated). Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) compared to those extubated/never intubated (median = 1 day). After accounting for differences in disease severity at treatment initiation, this apparent superiority of anakinra over tocilizumab was no longer statistically significant (propensity score-adjusted hazards ratio 0.46, 95% confidence interval 0.18–1.20). CONCLUSIONS: Prompt identification and treatment of COVID19-CS before intubation may be more important than the specific type of anti-inflammatory treatment. Randomized controlled trials of targeted anti-cytokine treatments and corticosteroids should report the duration of cytokine storm in addition to clinical severity at randomization. Southern California Permanente Medical Group. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2020-10 2020-08-06 /pmc/articles/PMC7406519/ /pubmed/32768693 http://dx.doi.org/10.1016/j.ijid.2020.07.081 Text en © 2020 Southern California Permanente Medical Group Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Langer-Gould, Annette
Smith, Jessica B.
Gonzales, Edlin G.
Castillo, Rhina D.
Figueroa, Judith Garza
Ramanathan, Anusha
Li, Bonnie H.
Gould, Michael K.
Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title_full Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title_fullStr Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title_full_unstemmed Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title_short Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
title_sort early identification of covid-19 cytokine storm and treatment with anakinra or tocilizumab
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406519/
https://www.ncbi.nlm.nih.gov/pubmed/32768693
http://dx.doi.org/10.1016/j.ijid.2020.07.081
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