Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
Objective: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). Methods: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from electronic health records. Results: At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only seven (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated). Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) compared to those extubated/never intubated (median = 1 day). After accounting for differences in disease severity at treatment initiation, this apparent superiority of anakinra over tocilizumab was no longer statistically significant (propensity score-adjusted hazards ratio 0.46, 95% confidence interval 0.18–1.20). Conclusions: Prompt identification and treatment of COVID19-CS before intubation may be more important than the specific type of anti-inflammatory treatment. Randomized controlled trials of targeted anti-cytokine treatments and corticosteroids should report the duration of cytokine storm in addition to clinical severity at randomization..
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:99 |
|---|---|
| Enthalten in: |
International Journal of Infectious Diseases - 99(2020), Seite 291-297 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Annette Langer-Gould [VerfasserIn] |
|---|
| Links: |
doi.org [kostenfrei] |
|---|
| Themen: |
Anakinra |
|---|
| doi: |
10.1016/j.ijid.2020.07.081 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
DOAJ051415356 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | DOAJ051415356 | ||
| 003 | DE-627 | ||
| 005 | 20230502094648.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 230227s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.ijid.2020.07.081 |2 doi | |
| 035 | |a (DE-627)DOAJ051415356 | ||
| 035 | |a (DE-599)DOAJeeaf6eb29a0c4baebd20d204d3664255 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 050 | 0 | |a RC109-216 | |
| 100 | 0 | |a Annette Langer-Gould |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Objective: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). Methods: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from electronic health records. Results: At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only seven (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated). Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) compared to those extubated/never intubated (median = 1 day). After accounting for differences in disease severity at treatment initiation, this apparent superiority of anakinra over tocilizumab was no longer statistically significant (propensity score-adjusted hazards ratio 0.46, 95% confidence interval 0.18–1.20). Conclusions: Prompt identification and treatment of COVID19-CS before intubation may be more important than the specific type of anti-inflammatory treatment. Randomized controlled trials of targeted anti-cytokine treatments and corticosteroids should report the duration of cytokine storm in addition to clinical severity at randomization. | ||
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Cytokine storm | |
| 650 | 4 | |a Anakinra | |
| 650 | 4 | |a Tocilizumab | |
| 650 | 4 | |a Corticosteroids | |
| 653 | 0 | |a Infectious and parasitic diseases | |
| 700 | 0 | |a Jessica B. Smith |e verfasserin |4 aut | |
| 700 | 0 | |a Edlin G. Gonzales |e verfasserin |4 aut | |
| 700 | 0 | |a Rhina D. Castillo |e verfasserin |4 aut | |
| 700 | 0 | |a Judith Garza Figueroa |e verfasserin |4 aut | |
| 700 | 0 | |a Anusha Ramanathan |e verfasserin |4 aut | |
| 700 | 0 | |a Bonnie H. Li |e verfasserin |4 aut | |
| 700 | 0 | |a Michael K. Gould |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i In |t International Journal of Infectious Diseases |d Elsevier, 2015 |g 99(2020), Seite 291-297 |w (DE-627)DOAJ000043923 |x 18783511 |7 nnns |
| 773 | 1 | 8 | |g volume:99 |g year:2020 |g pages:291-297 |
| 856 | 4 | 0 | |u https://doi.org/10.1016/j.ijid.2020.07.081 |z kostenfrei |
| 856 | 4 | 0 | |u https://doaj.org/article/eeaf6eb29a0c4baebd20d204d3664255 |z kostenfrei |
| 856 | 4 | 0 | |u http://www.sciencedirect.com/science/article/pii/S1201971220306093 |z kostenfrei |
| 856 | 4 | 2 | |u https://doaj.org/toc/1201-9712 |y Journal toc |z kostenfrei |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_DOAJ | ||
| 912 | |a SSG-OLC-PHA | ||
| 951 | |a AR | ||
| 952 | |d 99 |j 2020 |h 291-297 | ||