Comparison of anakinra and tocilizumab in management of severe COVID-19: a retrospective cohort study

Authors: ORHAN KÜÇÜKŞAHİN, ABDULSAMET ERDEN, ÖZLEM KARAKAŞ, SERDAR CAN GÜVEN, BERKAN ARMAĞAN, ENES SEYDA ŞAHİNER, OSMAN İNAN, ALİ CAN KURTİPEK, EMİN GEMCİOĞLU, SELMA KARAAHMETOĞLU, SEMA TURAN, SEVAL İZDEŞ, DENİZ ERDEM, ADALET AYPAK, MÜGE AYHAN, ESRAGÜL AKINCI, HURREM BODUR, HATİCE RAHMET GÜNER, AHMET OMMA, İHSAN ATEŞ

Abstract: Background/aim: 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. Materials and 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. Conclusion: 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.

Keywords: COVID-19, cytokine storm, hyperinflammation, anakinra, tocilizumab

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