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Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study
INTRODUCTION: Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS A...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782569/ https://www.ncbi.nlm.nih.gov/pubmed/33400157 http://dx.doi.org/10.1007/s11739-020-02600-z |
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author | Aomar-Millán, Ismael Francisco Salvatierra, Juan Torres-Parejo, Úrsula Faro-Miguez, Naya Callejas-Rubio, José Luis Ceballos-Torres, Ángel Cruces-Moreno, María Teresa Gómez-Jiménez, Francisco Javier Hernández-Quero, José Anguita-Santos, Francisco |
author_facet | Aomar-Millán, Ismael Francisco Salvatierra, Juan Torres-Parejo, Úrsula Faro-Miguez, Naya Callejas-Rubio, José Luis Ceballos-Torres, Ángel Cruces-Moreno, María Teresa Gómez-Jiménez, Francisco Javier Hernández-Quero, José Anguita-Santos, Francisco |
author_sort | Aomar-Millán, Ismael Francisco |
collection | PubMed |
description | INTRODUCTION: Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS: A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS: 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265–0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS: In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis. |
format | Online Article Text |
id | pubmed-7782569 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-77825692021-01-05 Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study Aomar-Millán, Ismael Francisco Salvatierra, Juan Torres-Parejo, Úrsula Faro-Miguez, Naya Callejas-Rubio, José Luis Ceballos-Torres, Ángel Cruces-Moreno, María Teresa Gómez-Jiménez, Francisco Javier Hernández-Quero, José Anguita-Santos, Francisco Intern Emerg Med Im - Original INTRODUCTION: Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS: A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS: 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265–0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS: In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis. Springer International Publishing 2021-01-05 2021 /pmc/articles/PMC7782569/ /pubmed/33400157 http://dx.doi.org/10.1007/s11739-020-02600-z Text en © Springer Nature Switzerland AG part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Im - Original Aomar-Millán, Ismael Francisco Salvatierra, Juan Torres-Parejo, Úrsula Faro-Miguez, Naya Callejas-Rubio, José Luis Ceballos-Torres, Ángel Cruces-Moreno, María Teresa Gómez-Jiménez, Francisco Javier Hernández-Quero, José Anguita-Santos, Francisco Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title | Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title_full | Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title_fullStr | Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title_full_unstemmed | Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title_short | Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study |
title_sort | anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe covid-19 pneumonia and moderate hyperinflammation. a retrospective cohort study |
topic | Im - Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782569/ https://www.ncbi.nlm.nih.gov/pubmed/33400157 http://dx.doi.org/10.1007/s11739-020-02600-z |
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