Efficacy and Safety of Anakinra Plus Standard of Care for Patients With Severe COVID-19
Authors: Fanlo Patricia , Gracia-Tello Borja del Carmelo , Fonseca Aizpuru Eva , Álvarez-Troncoso Jorge , Gonzalez Andrés , Prieto-González Sergio , Freire Mayka , Argibay Ana Belén , Pallarés Lucio , Todolí José Antonio , Pérez Mercedes , Buján-Rivas Segundo , Ibáñez Berta ,   GEAS-SEMI Group, Arnáez Rubén , Huarte Elisa , Sanchez Julio , Zabalza Eva , Garcia-Rey Ruth , Gonzalo Maria , Diez-Galán Laura , de la Rica-Escuín Marisa , Martinez-Lostao Luis , Marín Ballvé Adela , Taboada-Martínez María Luisa , Pampín-Sánchez Rubén , Helguera-Amézua Cristina , Fernández-Madera-Martínez Rosa , García-Coya Estela , Álvarez-Suarez Ana María , Robles Ángel , Noblejas Ana , Soto Clara , Martínez Elena , Arnalich Francisco , Arévalo Coral , López-Rodríguez Angélica  , Cobeta Pilar , Hidalgo Fernando , Diz Sergio , González Paula , Bara Nuria , Fabregate Martin , Jiménez Judith , Zhilina Svetlana , Pellicer-Ariño Martina , Rodríguez -Núñez Olga , Ribot -Grabalosa Joan , Costafreda-Mas Míriam , Tomé-Pérez Adrián , Hospital-Vidal Teresa , Ladino-Vázquez Andrea , Morancho-Sesé Alma , Salazar-Rustarazo Adelaido , Gabara-Xancó Cristina , Gonzalez -Quintela Arturo , Sopeña Bernardo , Alende -Sixto Rosario , Esteban Helena , Rodriguez-Nuñez Nuria , Andrade-Piña Ariadna Helena , Sanchidrian-Chapinal Maria Ángeles , Varela Pablo , Taboada Manuel , Maure-Noia Brenda , López-Domínguez Ana , Filloy-Mato Carmen , Gimena-Reyes Beatriz , Samartín-Ucha Marisol , Vázquez-Triñanes Caritina , Fernández-Martín Julian , Paradela-Carreiro Adolfo , Regueira-Arcay Ana María , Esteban-Marcos Eva , Martin-Pena Luisa , Fernández-Navarro Juan Antonio , Abdilla-Bonias Noelia , Mestre-Torres Jaume , Marques-Soares Joana Rita , Pardos-Gea Josep 
Published: April 2023

Importance

COVID-19 pneumonia is often associated with hyperinflammation. The efficacy and safety of anakinra in treating patients with severe COVID-19 pneumonia and hyperinflammation are still unclear.

Objective

To assess the efficacy and safety of anakinra vs standard of care alone for patients with severe COVID-19 pneumonia and hyperinflammation.

Design, Setting, and Participants

The Clinical Trial of the Use of Anakinra in Cytokine Storm Syndrome Secondary to COVID-19 (ANA-COVID-GEAS) was a multicenter, randomized, open-label, 2-group, phase 2/3 clinical trial conducted at 12 hospitals in Spain between May 8, 2020, and March 1, 2021, with a follow-up of 1 month. Participants were adult patients with severe COVID-19 pneumonia and hyperinflammation. Hyperinflammation was defined as interleukin-6 greater than 40 pg/mL, ferritin greater than 500 ng/mL, C-reactive protein greater than 3 mg/dL (rationale, ≥5 upper normal limit), and/or lactate dehydrogenase greater than 300 U/L. Severe pneumonia was considered if at least 1 of the following conditions was met: ambient air oxygen saturation 94% or less measured with a pulse oximeter, ratio of partial pressure O2 to fraction of inspired O2 of 300 or less, and/or a ratio of O2 saturation measured with pulse oximeter to fraction of inspired O2 of 350 or less. Data analysis was performed from April to October 2021.

Interventions

Usual standard of care plus anakinra (anakinra group) or usual standard of care alone (SoC group). Anakinra was given at a dose of 100 mg 4 times a day intravenously.

Main Outcomes and Measures

The primary outcome was the proportion of patients not requiring mechanical ventilation up to 15 days after treatment initiation, assessed on an intention-to-treat basis.

Results

A total of 179 patients (123 men [69.9%]; mean [SD] age, 60.5 [11.5] years) were randomly assigned to the anakinra group (92 patients) or to the SoC group (87 patients). The proportion of patients not requiring mechanical ventilation up to day 15 was not significantly different between groups (64 of 83 patients [77.1%] in the anakinra group vs 67 of 78 patients [85.9%] in the SoC group; risk ratio [RR], 0.90; 95% CI, 0.77-1.04; P = .16). Anakinra did not result in any difference in time to mechanical ventilation (hazard ratio, 1.72; 95% CI, 0.82-3.62; P = .14). There was no significant difference between groups in the proportion of patients not requiring invasive mechanical ventilation up to day 15 (RR, 0.99; 95% CI, 0.88-1.11; P &amp;gt; .99).

Conclusions and Relevance

In this randomized clinical trial, anakinra did not prevent the need for mechanical ventilation or reduce mortality risk compared with standard of care alone among hospitalized patients with severe COVID-19 pneumonia.

Trial Registration

ClinicalTrials.gov Identifier: NCT04443881