Early identification of COVID-19 cytokine storm and treatment with anakinra or tocilizumab
Copyright © 2020 Southern California Permanente Medical Group. Published by Elsevier Ltd.. All rights reserved..
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.
| Errataetall: |
CommentIn: Int J Infect Dis. 2020 Dec;101:247-248. - PMID 33011285 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:99 |
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| Enthalten in: |
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases - 99(2020) vom: 29. Okt., Seite 291-297 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Langer-Gould, Annette [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 02.11.2020 Date Revised 10.01.2021 published: Print-Electronic CommentIn: Int J Infect Dis. 2020 Dec;101:247-248. - PMID 33011285 Citation Status MEDLINE |
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| doi: |
10.1016/j.ijid.2020.07.081 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM313437238 |
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| 100 | 1 | |a Langer-Gould, Annette |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 | |
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| 500 | |a Date Completed 02.11.2020 | ||
| 500 | |a Date Revised 10.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Int J Infect Dis. 2020 Dec;101:247-248. - PMID 33011285 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Southern California Permanente Medical Group. Published by Elsevier Ltd.. All rights reserved. | ||
| 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 Journal Article | |
| 650 | 4 | |a Anakinra | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Cytokine storm | |
| 650 | 4 | |a Tocilizumab | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 650 | 7 | |a Anti-Inflammatory Agents |2 NLM | |
| 650 | 7 | |a Antibodies, Monoclonal, Humanized |2 NLM | |
| 650 | 7 | |a Cytokines |2 NLM | |
| 650 | 7 | |a Interleukin 1 Receptor Antagonist Protein |2 NLM | |
| 650 | 7 | |a tocilizumab |2 NLM | |
| 650 | 7 | |a I031V2H011 |2 NLM | |
| 700 | 1 | |a Smith, Jessica B |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzales, Edlin G |e verfasserin |4 aut | |
| 700 | 1 | |a Castillo, Rhina D |e verfasserin |4 aut | |
| 700 | 1 | |a Figueroa, Judith Garza |e verfasserin |4 aut | |
| 700 | 1 | |a Ramanathan, Anusha |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Bonnie H |e verfasserin |4 aut | |
| 700 | 1 | |a Gould, Michael K |e verfasserin |4 aut | |
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