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

Objectives: A subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease. Methods: A prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with 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 6-point ordinal scale, from baseline to day 21. Results: 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. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527). Conclusions: Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.