Effectiveness of anakinra for tocilizumab-refractory severe COVID-19. A single centre retrospective comparative study

https://doi.org/10.1016/j.ijid.2021.02.041

A prospective cohort of patients with COVID19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) to selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a six-point ordinal scale, from baseline to day 21. The study included 20 cases and 20 controls (mean age 65.3+/-12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. In-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P=0.527). Treatment with anakinra was not useful to improve the prognosis of patients with tocilizumab-refractory severe COVID-19

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