Favorable Anakinra Responses in COVID-19 Patients with Severe Respiratory Failure
17 Pages Posted: 29 Apr 2020 Publication Status: Published
More...Abstract
Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe complications of Covid-19, with IL-1/IL-6 pathway being central in these events. Eight patients with severe Covid-19 pneumonia treated with the interleukin-1 receptor antagonist anakinra are reported; seven patients hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands. Patients scored positive for the hemophagocytosis score and they were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH). At the end-of-treatment with anakinra, ICU patients had less demands on vasopressors; they also had lower C-reactive protein, procalcitonin, troponin I, D-dimers, and ferritin - the hallmark marker of sHLH. All patients improved their respiratory function. Only two patients died. These data argue that the administration of anakinra may be a viable treatment in severe Covid-19 with sHLH, supporting for larger clinical studies to validate this concept.
Note: Funding: The study was funded in part by the Horizon 2020 grant ImmunoSep (#847422) and in part by the Hellenic Institute for the Study of Sepsis. MGN was supported by an ERC Advanced grant (#833247) and a Spinoza grant of the Netherlands Organization for Scientific Research.
Conflict of Interest: E.J. Giamarellos-Bourboulis has received honoraria from AbbVie USA, Abbott CH, InflaRx GmbH, MSD Greece, XBiotech Inc. and Angelini Italy; independent educational grants from AbbVie, Abbott, Astellas Pharma Europe, AxisShield, bioMérieux Inc, InflaRx GmbH, and XBiotech Inc; and funding from the FrameWork 7 program HemoSpec (granted to the National and Kapodistrian University of Athens), the Horizon2020 Marie-Curie Project European Sepsis Academy (granted to the National and Kapodistrian University of Athens), and the Horizon 2020 European Grant ImmunoSep (granted to the Hellenic Institute for the Study of Sepsis). Mihai G. Netea is supported by an ERC Advanced Grant (#833247) and a Spinoza grant of the Netherlands Organization for Scientific Research. Frank L van de Veerdonk was supported by a Vidi grant of the Netherlands Association for Scientific Research.
Keywords: hemophagocytic lymphohistocytosis, COVID-19, anakinra, ferritin, respiratory function
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