Anakinra or high-dose corticosteroids in COVID-19 pneumonia patients who deteriorate on low-dose dexamethasone: an observational study of comparative effectiveness
Objectives: To assess whether escalating to high-dose corticosteroids or anakinra compared with continuing low-dose corticosteroids reduced mortality in patients with severe COVID-19 whose respiratory function deteriorated while receiving dexamethasone 6 mg daily. Methods: We conducted a retrospective cohort study between March 1 to December 31, 2020, of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone <10 mg daily), or remaining on low-dose corticosteroids on the day of first respiratory deterioration. Results: We analyzed 6671 patients whose respiratory status deteriorated while receiving dexamethasone 6 mg daily for COVID-19 pneumonia, of whom 6265 stayed on low-dose corticosteroids, 232 were escalated to high-dose corticosteroids, and 174 to anakinra in addition to corticosteroids. The propensity score-adjusted odds of death were higher in the anakinra (odds ratio [OR] 1.76; 95% CI 1.13-2.72) and high-dose corticosteroid groups (OR 1.53; 95% CI 1.14-2.07) compared with those who continued low-dose corticosteroids on the day of respiratory deterioration. The odds of hospital-acquired infections were also higher in the anakinra (OR 2.00; 95% CI 1.28-3.11) and high-dose corticosteroid groups (OR 1.43; 95% CI 1.00-2.04) compared with low-dose corticosteroid group. Conclusion: Our findings do not support escalating patients with COVID-19 pneumonia who deteriorate on low-dose corticosteroids to high-dose corticosteroids or anakinra..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:126 |
|---|---|
| Enthalten in: |
International Journal of Infectious Diseases - 126(2023), Seite 87-93 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Annette Langer-Gould [VerfasserIn] |
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| Links: |
doi.org [kostenfrei] |
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| Themen: |
Anakinra |
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| doi: |
10.1016/j.ijid.2022.11.017 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
DOAJ020801807 |
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| 245 | 1 | 0 | |a Anakinra or high-dose corticosteroids in COVID-19 pneumonia patients who deteriorate on low-dose dexamethasone: an observational study of comparative effectiveness |
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| 520 | |a Objectives: To assess whether escalating to high-dose corticosteroids or anakinra compared with continuing low-dose corticosteroids reduced mortality in patients with severe COVID-19 whose respiratory function deteriorated while receiving dexamethasone 6 mg daily. Methods: We conducted a retrospective cohort study between March 1 to December 31, 2020, of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone <10 mg daily), or remaining on low-dose corticosteroids on the day of first respiratory deterioration. Results: We analyzed 6671 patients whose respiratory status deteriorated while receiving dexamethasone 6 mg daily for COVID-19 pneumonia, of whom 6265 stayed on low-dose corticosteroids, 232 were escalated to high-dose corticosteroids, and 174 to anakinra in addition to corticosteroids. The propensity score-adjusted odds of death were higher in the anakinra (odds ratio [OR] 1.76; 95% CI 1.13-2.72) and high-dose corticosteroid groups (OR 1.53; 95% CI 1.14-2.07) compared with those who continued low-dose corticosteroids on the day of respiratory deterioration. The odds of hospital-acquired infections were also higher in the anakinra (OR 2.00; 95% CI 1.28-3.11) and high-dose corticosteroid groups (OR 1.43; 95% CI 1.00-2.04) compared with low-dose corticosteroid group. Conclusion: Our findings do not support escalating patients with COVID-19 pneumonia who deteriorate on low-dose corticosteroids to high-dose corticosteroids or anakinra. | ||
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Anakinra | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Infections | |
| 653 | 0 | |a Infectious and parasitic diseases | |
| 700 | 0 | |a Stanley Xu |e verfasserin |4 aut | |
| 700 | 0 | |a Laura C. Myers |e verfasserin |4 aut | |
| 700 | 0 | |a Aiyu Chen |e verfasserin |4 aut | |
| 700 | 0 | |a John D. Greene |e verfasserin |4 aut | |
| 700 | 0 | |a Beth Creekmur |e verfasserin |4 aut | |
| 700 | 0 | |a Katia Bruxvoort |e verfasserin |4 aut | |
| 700 | 0 | |a John L. Adams |e verfasserin |4 aut | |
| 700 | 0 | |a Vincent Liu |e verfasserin |4 aut | |
| 700 | 0 | |a Michael K. Gould |e verfasserin |4 aut | |
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