COVID-19 and Rheumatology

COVID-19 and Rheumatology

Perspective from Barbara Kienzle, BSN, RN
Disclosures: Milionis reports honoraria and non-financial support from Amgen, Angelini, Bayer, MSD, Pfizer, Sanofi and Servier. Please see the study for all other authors’ relevant financial disclosures.
June 24, 2021
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Anakinra lowers ventilation, mortality risk in non-intubated patients with COVID-19

Perspective from Barbara Kienzle, BSN, RN
Disclosures: Milionis reports honoraria and non-financial support from Amgen, Angelini, Bayer, MSD, Pfizer, Sanofi and Servier. Please see the study for all other authors’ relevant financial disclosures.
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Anakinra safely reduces the need for invasive mechanical ventilation and mortality risk in patients with COVID-19 who are hospitalized, but non-intubated, according to a meta-analysis published in Rheumatology.

“A subgroup of SARS-CoV-2 infected patients manifest hyperinflammatory symptoms that resemble the cytokine storm syndromes characterized by increased release of chemokines, growth factors and cytokines, including interleukins,” Haralampos Milionis, MD, PhD, of the University of Ioannina, in Greece, and colleagues wrote. “In this context, anakinra, an IL-1 receptor antagonist, used for the treatment of autoinflammatory disorders, has been considered in such patients.”

Anakinra reduces the need for invasive mechanical ventilation and mortality risk in patients who are hospitalized, but non-intubated, with COVID-19, according to a meta-analysis. Data derived from Barkas F, et al. Rheumatology. 2021;doi:10.1093/rheumatology/keab447.

“Previous reports have demonstrated beneficial effects with anakinra in severe sepsis with multiorgan inflammatory dysfunction or secondary hemophagocytic lymphohistiocytosis, whereas case series and two recently published open label trials have shown that treatment with anakinra is associated with laboratory and clinical improvement in COVID-19 patients with hyperinflammation,” they added.

To examine the efficacy and safety of anakinra (Kineret, SOBI) in hospitalized, non-intubated adults with COVID-19, Milionis and colleagues conducted a systemic review and meta-analysis. Relevant studies were identified through a literature search of relevant terms — “anakinra,” “interleukin 1,” “coronavirus,” “COVID-19” and “SARS-CoV-2” — through April 24.

Haralampos Milionis

Inclusion criteria were studies that assessed the effect of anakinra on the need for invasive mechanical ventilation and mortality in hospitalized non-intubated patients with COVID-19. In all, nine studies, featuring a total of 1,119 patients, met the criteria and were included in the analysis.

According to the researchers, the studies’ bias risks regarding the assessed parameters were high. However, in the pooled analysis, anakinra reduced the need for invasive mechanical ventilation (OR = 0.38; 95% CI, 0.17-0.85) and mortality risk (OR = 0.32; 95% CI, 0.23-0.45), compared with standard therapy. In addition, there were no differences in the risk for adverse events, including liver dysfunction (OR = 0.75; 95% CI, 0.48-1.16) and bacteremia (OR = 1.07; 95% CI, 0.42-2.73), between anakinra and standard therapy.

“Anakinra reduces the need for invasive mechanical ventilation and lowers mortality risk in hospitalized non-intubated patients with COVID-19, without increasing the risk of adverse events, such as liver dysfunction or bacteremia,” Milionis told Healio Rheumatology.

“Considering the noticed shortage of ICU beds and consequently the increased burden in medical wards during the current pandemic, identifying therapeutic modalities to improve adverse outcomes and prevent ICU admission and death in this population remains a public health emergency,” he added. “Therefore, our results are awaiting to be confirmed by randomized placebo-controlled trials.”