Anakinra for patients with COVID-19: a meta-analysis of non-randomized cohort studies.

Abstract

INTRODUCTION:

Severe COVID-19 cases have a detrimental hyper-inflammatory host response and different cytokine-blocking biologic agents were explored to improve outcomes. Anakinra blocks the activity of both IL-1α and IL‑1β and is approved for different autoinflammatory disorders, but it is used off-label for conditions characterized by an excess of cytokine production. Several studies on anakinra in COVID-19 patients reported positive effects. We performed a meta-analysis of all published evidence on the use of anakinra in COVID19 to investigate its effect on survival and need for mechanical ventilation.

METHODS:

We searched for any study performed on adult patients with acute hypoxemic failure related to 2019-nCoV infection, receiving anakinra versus any comparator. Primary endpoint was mortality at the longest available follow-up. Adverse effects, need for mechanical ventilation and discharge at home with no limitations were also analysed.

RESULTS:

Four observational studies involving 184 patients were included. Overall mortality of patients treated with anakinra was significantly lower than mortality in the control group (95% CI 0.14-0.48, p<0.0001). Moreover, patients treated with anakinra had a significantly lower risk of need for mechanical ventilation than controls (95% CI 0.250.74, p=0.002). No difference in adverse events and discharge at home with no limitations was observed. The Trial Sequential Analysis z-cumulative line reached the monitoring boundary for benefit and the required sample size.

CONCLUSIONS:

Administration of anakinra in COVID-19 patients was safe and might be associated with reductions in both mortality and need for mechanical ventilation. Randomized clinical trials are warranted to confirm these findings.

• Authors: Laura Pasin, Giulio Cavalli, Paolo Navalesi, Nicolò Sella, Giovanni Landoni, Andrey G Yavorovskiy, Valery V Likhvantsev, Alberto Zangrillo, Lorenzo Dagna, Giacomo Monti
• Journal: European journal of internal medicine (Eur J Intern Med) Vol. 86 Pg. 34-40 (04 2021) ISSN: 1879-0828 [Electronic] Netherlands
• PMID: 33581979 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Interleukin 1 Receptor Antagonist Protein

Topics

• Adult
• COVID-19
• Cohort Studies
• Humans
• Interleukin 1 Receptor Antagonist Protein (therapeutic use)
• Respiration, Artificial
• SARS-CoV-2
• Treatment Outcome