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Safety of intravenous anakinra in COVID-19 with evidence of hyperinflammation, a case series

Clark, KEN; Collas, O; Lachmann, H; Singh, A; Buckley, J; Bhagani, S; (2020) Safety of intravenous anakinra in COVID-19 with evidence of hyperinflammation, a case series. Rheumatology Advances in Practice , 4 (2) , Article rkaa040. 10.1093/rap/rkaa040. Green open access

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Abstract

Objectives Anakinra is a selective IL-1 inhibitor, which has been used in the context of secondary haemophagocytic lymphohistiocytosis. Although usually given in the s.c. form, previous anecdotal reports have emphasized its utility when given i.v. Our aim is to report our experience on the beneficial effects of anakinra i.v. in patients with SARS-CoV-2 and evidence of hyperinflammation. Methods We report four patients with severe COVID-19 infection requiring intensive care admission and ventilatory support. Results All four patients showed evidence of deterioration, with hyperferritinaemia and increasing oxygen requirements and with superadded bacterial infections. Upon commencement of anakinra i.v., there was subsequent improvement in the patients clinically, with reduction in ventilatory support and inotropic support, and biochemically, with rapid improvement in inflammatory markers. Conclusion Anakinra is safe to use i.v. in patients with COVID-19 and evidence of superadded bacterial infection. Although its utility has not been confirmed in a randomized trial, current research in the COVID-19 pandemic aims to establish the utility of immunosuppression, including IL-1 blockade, on the outcomes of patients with moderate to severe disease. Our case series supports its use in patients with severe, life-threatening COVID-19 and evidence of hyperinflammation.

Type: Article
Title: Safety of intravenous anakinra in COVID-19 with evidence of hyperinflammation, a case series
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/rap/rkaa040
Publisher version: https://doi.org/10.1093/rap/rkaa040
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Keywords: COVID-19, haemophagocytic lymphohistiocytosis, anakinra, hyperinflammation
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/10110838
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