tetano
Editor, Senior Moderator
Rheumatology (Oxford)
. 2021 May 17;keab447.
doi: 10.1093/rheumatology/keab447. Online ahead of print.
Anakinra in hospitalized non-intubated patients with coronavirus disease 2019: a systematic review and meta-analysis
Fotios Barkas[SUP] 1 [/SUP], Sebastian Filippas Ntekouan[SUP] 1 [/SUP], Maria Kosmidou[SUP] 1 [/SUP], Evangelos Liberopoulos[SUP] 1 [/SUP], Angelos Liontos[SUP] 1 [/SUP], Haralampos Milionis[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Acute respiratory distress syndrome and cytokine release syndrome are the major complications of coronavirus disease 2019 (COVID-19) associated with increased mortality risk.
Objectives: We performed a meta-analysis to assess the efficacy and safety of anakinra in adult hospitalized non-intubated patients with COVID-19.
Search methods: Relevant trials were identified by searching literature until 24 April 2021 using the following terms: anakinra, interleukin 1, coronavirus, COVID-19, SARS-CoV-2.
Selection criteria: Trials evaluating the effect of anakinra on the need for invasive mechanical ventilation and mortality in hospitalized non-intubated patients with COVID-19.
Results: Nine studies (n = 1,119) were eligible for inclusion in the present meta-analysis. Their bias risk with reference to the assessed parameters was high. In pooled analyses, anakinra reduced the need for invasive mechanical ventilation (odds ratio, OR: 0?38, 95% confidence interval, CI: 0?17-0?85, p= 0.02, I2=67%; 6 studies, n = 587) and mortality risk (OR: 0?32, 95% CI: 0?23-0?45, p< 0?00001, I2=0%; 9 studies, n = 1,119) compared with standard of care therapy. There were no differences regarding the risk of adverse events, including liver dysfunction (OR: 0?75, 95% CI: 0?48-1?16, p> 0?05, I2=28%; 5 studies, n = 591) and bacteremia (OR: 1?07, 95% CI: 0?42-2?73, p> 0?05, I2=71%; 6 studies, n = 727).
Conclusions: Available evidence shows that treatment with anakinra reduces both the need for invasive mechanical ventilation and mortality risk of hospitalized non-intubated patients with COVID-19 without increasing the risk of adverse events. Confirmation of efficacy and safety requires randomized placebo-controlled trials.
Keywords: COVID-19; SARS-CoV-2; anakinra; coronavirus; interleukin 1.
. 2021 May 17;keab447.
doi: 10.1093/rheumatology/keab447. Online ahead of print.
Anakinra in hospitalized non-intubated patients with coronavirus disease 2019: a systematic review and meta-analysis
Fotios Barkas[SUP] 1 [/SUP], Sebastian Filippas Ntekouan[SUP] 1 [/SUP], Maria Kosmidou[SUP] 1 [/SUP], Evangelos Liberopoulos[SUP] 1 [/SUP], Angelos Liontos[SUP] 1 [/SUP], Haralampos Milionis[SUP] 1 [/SUP]
Affiliations
- PMID: 33999135
- DOI: 10.1093/rheumatology/keab447
Abstract
Background: Acute respiratory distress syndrome and cytokine release syndrome are the major complications of coronavirus disease 2019 (COVID-19) associated with increased mortality risk.
Objectives: We performed a meta-analysis to assess the efficacy and safety of anakinra in adult hospitalized non-intubated patients with COVID-19.
Search methods: Relevant trials were identified by searching literature until 24 April 2021 using the following terms: anakinra, interleukin 1, coronavirus, COVID-19, SARS-CoV-2.
Selection criteria: Trials evaluating the effect of anakinra on the need for invasive mechanical ventilation and mortality in hospitalized non-intubated patients with COVID-19.
Results: Nine studies (n = 1,119) were eligible for inclusion in the present meta-analysis. Their bias risk with reference to the assessed parameters was high. In pooled analyses, anakinra reduced the need for invasive mechanical ventilation (odds ratio, OR: 0?38, 95% confidence interval, CI: 0?17-0?85, p= 0.02, I2=67%; 6 studies, n = 587) and mortality risk (OR: 0?32, 95% CI: 0?23-0?45, p< 0?00001, I2=0%; 9 studies, n = 1,119) compared with standard of care therapy. There were no differences regarding the risk of adverse events, including liver dysfunction (OR: 0?75, 95% CI: 0?48-1?16, p> 0?05, I2=28%; 5 studies, n = 591) and bacteremia (OR: 1?07, 95% CI: 0?42-2?73, p> 0?05, I2=71%; 6 studies, n = 727).
Conclusions: Available evidence shows that treatment with anakinra reduces both the need for invasive mechanical ventilation and mortality risk of hospitalized non-intubated patients with COVID-19 without increasing the risk of adverse events. Confirmation of efficacy and safety requires randomized placebo-controlled trials.
Keywords: COVID-19; SARS-CoV-2; anakinra; coronavirus; interleukin 1.