Back to Search
Start Over
Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series
- Source :
- Arthritis & Rheumatology, Arthritis & Rheumatology (Hoboken, N.j.)
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Objective To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID-19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure. Methods To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6-liter nasal cannula or use of ≥95% oxygen by high-flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation. Results Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation. Conclusion Our data suggest that anakinra could be beneficial in treating COVID-19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID-19 and symptoms of cytokine storm syndrome.
- Subjects :
- 0301 basic medicine
musculoskeletal diseases
Coronavirus disease 2019 (COVID-19)
medicine.medical_treatment
Immunology
medicine.disease_cause
03 medical and health sciences
0302 clinical medicine
Rheumatology
Recurrence
medicine
Humans
Pericarditis
Immunology and Allergy
030212 general & internal medicine
Mechanical ventilation
Anakinra
business.industry
SARS-CoV-2
Brief Report
COVID-19
Retrospective cohort study
medicine.disease
Clinical trial
Cytokine release syndrome
Interleukin 1 Receptor Antagonist Protein
030104 developmental biology
Anesthesia
Brief Reports
business
Cytokine storm
Nasal cannula
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 23265205 and 23265191
- Database :
- OpenAIRE
- Journal :
- Arthritis & Rheumatology
- Accession number :
- edsair.doi.dedup.....b3b00dfc505b78dd3acee43714b132d7
- Full Text :
- https://doi.org/10.1002/art.41422