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Comparison of anakinra and tocilizumab in management of severe COVID-19: a retrospective cohort study.
Küçüksahin, Orhan; Erden, Abdulsamet; Karakas, Özlem; Güven, Serdar Can; Armagan, Berkan; Sahiner, Enes Seyda; Inan, Osman; Kurtipek, Ali Can; Gemcioglu, Emin; Karaahmetoglu, Selma; Turan, Sema; Izdes, Seval; Erdem, Deniz; Aypak, Adalet; Ayhan, Müge; Akinci, Esragül; Bodur, Hürrem; Güner, Rahmet; Omma, Ahmet; Ates, Ihsan.
  • Küçüksahin O; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
  • Erden A; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
  • Karakas Ö; Clinic of Rheumatology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Güven SC; Clinic of Rheumatology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Armagan B; Clinic of Rheumatology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Sahiner ES; Clinic of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Inan O; Clinic of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Kurtipek AC; Clinic of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Gemcioglu E; Clinic of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Karaahmetoglu S; Clinic of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Turan S; Clinic of Intensive Care Unit, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Izdes S; Department of Anesthesiology and Reanimation-Critical Care, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
  • Erdem D; Clinic of Anesthesia and Resuscitation, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Aypak A; Clinic of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Ayhan M; Clinic of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
  • Akinci E; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
  • Bodur H; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
  • Güner R; Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
  • Omma A; Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
  • Ates I; Department of Internal Medicine, Faculty of Medicine, Health Sciences University, Ankara City Hospital, Ankara, Turkey.
Turk J Med Sci ; 52(5): 1486-1494, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2091802
ABSTRACT

BACKGROUND:

Studies regarding effectiveness of anakinra and tocilizumab treatments in coronavirus disease 2019 (COVID-19) have contradictory results. Furthermore, there is scarce comparative data regarding superiority of any agent. To further elucidate any superiority between these two agents, we retrospectively investigated and compared outcomes in hospitalized COVID-19 patients of our inpatient cohort who received anakinra or tocilizumab.

METHODS:

This study was designed as a single-center, retrospective, cross-sectional cohort study. Hospitalized patients with confirmed diagnosis of COVID-19 who had Brescia-COVID respiratory severity scale score ≥3 and hyperinflammation (defined as elevation of C reactive protein ≥50 g/L or ferritin ≥700 ng/mL) and received anakinra or tocilizumab in addition to standard care were enrolled in the study. Length of hospital stay after initiation of antiinflammatory treatment, need for mechanical ventilation, need for intensive care unit admission, mortality were set as primary outcomes and compared between tocilizumab and anakinra recipients after propensity score matching.

RESULTS:

One hundred and six patients were placed in each group after propensity score matching. In the anakinra group, relative risk reduction for intensive care unit admission was 50% when compared to the tocilizumab group and the number needed to treat to avert an intensive care unit admission was 3 (95% CI, 2-5). In terms of mortality, a 52% relative risk reduction was observed with anakinra treatment and the number needed to treat to avert an intensive care unit admission was 8 (95% CI, 4-50). Significantly more patients were observed to receive glucocorticoids in the anakinra group.

DISCUSSION:

Anakinra administration in severe COVID-19 patients was significantly associated with better survival and greater clinical improvement compared to the tocilizumab administration in our study. Increased rate of glucocorticoid use in the anakinra group might have contributed to better outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Interleukin 1 Receptor Antagonist Protein / COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Turk J Med Sci Year: 2022 Document Type: Article Affiliation country: 1300-0144.5487

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Interleukin 1 Receptor Antagonist Protein / COVID-19 Drug Treatment Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Turk J Med Sci Year: 2022 Document Type: Article Affiliation country: 1300-0144.5487