• Cristina de la Calle, Francisco López-Medrano, José Luis Pablos, Jaime Lora-Tamayo, Guillermo Maestro-de la Calle, Marcos Sánchez-Fernández, Mario Fernández-Ruiz, María Asunción Pérez-Jacoiste Asín, José Manuel Caro-Teller, Rocío García-García, Mercedes Catalán, Joaquín Martínez-López, Ángel Sevillano, Julia Origüen, Mar Ripoll, San JuanRafaelRUnit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Spain., Antonio Lalueza, Borja de Miguel, Octavio Carretero, Fernando Aguilar, Carlos Gómez, Estela Paz-Artal, Héctor Bueno, Carlos Lumbreras, and José María Aguado.
• Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
• Int. J. Infect. Dis. 2021 Apr 1; 105: 319-325.

ObjectivesA subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease.MethodsA prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline, and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a 6-point ordinal scale, from baseline to day 21.ResultsThe study included 20 cases and 20 controls (mean age 65.3 ± 12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527).ConclusionsTreatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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