A new score to predict severe respiratory failure and guide anakinra treatment in COVID-19 pneumonia: analysis of the randomized SAVE-MORE trial

Introduction: Anakinra treatment is approved for the treatment of COVID-19 pneumonia in hospitalized adults in need of oxygen and at risk for progression into severe respiratory failure (SRF) defined as circulating concentrations of the biomarker suPAR (soluble urokinase plasminogen activator receptor) >= 6 ng/mL by the EMA and has been authorized for emergency use by FDA under an EUA [1]. This is based on the results of the randomized SAVE-MORE trial where suPAR >= 6 ng/ mL was used to select patients at risk for SRF [2]. The suPAR test is not commercially available in the USA and an alternative method of patient selection was needed. Method(s): In collaboration with the US FDA, an alternative method to select patients most likely to have suPAR >= 6 ng/mL based on commonly measured patient characteristics was developed. Patients with at least 3 of the following criteria are considered likely to have suPAR >= 6 ng/ ml: age >= 75 years, severe pneumonia by WHO criteria, current/previous smoking status, Sequential Organ Failure Assessment score >= 3, neutrophil-to-lymphocyte ratio >= 7, hemoglobin <= 10.5 g/dl, history of ischemic stroke, blood urea >= 50 mg/dl and/or history of renal disease. Result(s): The positive predictive value of this new score was 95.4% in SAVE-MORE population. However, a lower sensitivity meant a small proportion of patients with suPAR >= 6 ng/ml will not be identified by the new score. The adjusted hazard ratio for survival at 60 days for patients meeting this score and who receive anakinra is 0.45 (Fig. 1). Conclusion(s): The developed score predicts accurately patients with suPAR levels >= 6 ng/mL and may be used as an alternative to guide anakinra treatment in patients with COVID-19 pneumonia. Based on these subgroup results, patients in SAVE-MORE who met the new score appeared to show beneficial efficacy results with treatment of anakinra consistent with the overall studied population.

Models of hospital care during COVID-19 pandemic in Italy: results from a survey of physicians

During COVID-19 pandemic, COVID Hospitals were created throughout Italy and several different models of care for COVID-19 patients were implemented. Methods. We conducted a survey on physicians dedicated to the care of COVID-19 patients with the aim of describing specific models of hospital care that were implemented during the first wave of the pandemic in Italy. The survey included seven questions with an estimated response time of approximately 5 minutes. The questionnaire went through a face validation process and pilot testing. The final version of the questionnaire was disseminated through a national limited social platform for physicians involved in the care of COVID-19 patients. Results. In the time period between May 1st, 2020 and July 1st, 2020, 350 physicians from all over the Country participated to the survey. In most cases, old departments were transformed to COVID units, and new units dedicated to COVID-19 patients were created. A multidisciplinary team of specialists was available in half of the models of care described. The geriatrician was always part of the mulridisciplinary team. Over one third of the multidisciplinary teams for the care of COVID-19 patients also included infectious diseases specialists and pulmonologists. Conclusions. According to findings from our survey, co-management of care and multidisciplinary models were available for half of COVID-19 patients during the first wave of pandemic. Such models may offer significant advantages in terms of favourable outcomes and mortality, especially in complex older adults. © by Società Italiana di Gerontologia e Geriatria (SIGG).

Determinants of SARS-COV-2 seroconversion in a cohort of recovered patients

Not available.

"Say Ninetynine": It's Never too Late to Recover from COVID-19.

COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, showed higher severity and lethality in male older adults . There are currently no specific treatments. Studies are evaluating the efficacy of monoclonal antibodies against interleukin-6 receptor. Here we present the case of a 98-years old man admitted to our COVID-Hospital with acute respiratory failure. Comprehensive geriatric assessment showed no signs of frailty. First-line therapy with hydroxychloroquine and anticoagulants was not effective. Patient was administered intravenous monoclonal antibodies, and he showed remarkable clinical improvement. This case suggests that age alone should not preclude access to new therapeutic approaches. Comprehensive, multisciplinary, multidomain approaches are needed to develop patient-tailored treatments against COVID-19.

Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab.

A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.