Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia.
Efficacy of early anti-inflammatory treatment with high doses of intravenous anakinra with or without glucocorticoids in patients with severe COVID-19 pneumonia.
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DOI：
10.1016/j.jaci.2021.01.024
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Gattorno M
中科院分区：
文献类型：
--
作者：
Pontali E;Volpi S;Signori A;Antonucci G;Castellaneta M;Buzzi D;Montale A;Bustaffa M;Angelelli A;Caorsi R;Giambruno E;Bobbio N;Feasi M;Gueli I;Tricerri F;Calautti F;Castagnola E;Moscatelli A;Rollandi GA;Ravelli A;Cassola G;Sormani MP;Gattorno M
IL-1在细胞因子风暴综合征期间的炎症反应中起关键作用。我们的目的是分析静脉阿那白滞素联合或不联合糖皮质激素的早期抗炎治疗（AIT）在2019冠状病毒病（COVID-19）肺炎中的有效性和安全性。我们对2020年2月26日至4月29日因COVID-19肺炎入院的患者进行了一项回顾性单中心队列研究，以评估早期AIT的疗效，其中单独静脉注射阿那白滞素（100 mg，每8小时一次，持续3天，逐渐减少）或联合糖皮质激素（静脉注射甲泼尼龙，每日1-2 mg/kg，逐渐减少）。标准治疗（SOC）为羟氯喹和/或阿奇霉素，伴或不伴抗病毒药物和抗凝剂。还评价了阿那白滞素或托珠单抗的晚期补救AIT。通过倾向评分校正的考克斯模型评估治疗对总生存期的影响。共分析了128例患者; 63例患者在入院时接受了早期AIT（30例接受阿那白滞素单药治疗，33例接受阿那白滞素加糖皮质激素治疗），65例患者未接受早期AIT并用作对照;在后65例患者中，44例仅接受SOC治疗，21例接受SOC治疗加晚期补救AIT。校正所有不平衡的基线协变量后，早期AIT使死亡风险降低了74%（校正风险比[HR] = 0.26; P <0.001）。单用阿那白滞素（校正HR = 0.28; P = 0.04）和阿那白滞素加糖皮质激素（校正HR = 0.33; P = 0.07）的患者的效果相似。晚期补救治疗与SOC单独治疗相比未显示出显著优势（校正HR = 0.82; P = 0.70）。这项研究表明，在一个更大的COVID-19肺炎患者系列中，早期使用大剂量静脉注射阿那白滞素联合或不联合糖皮质激素的潜在疗效和安全性。
IL-1 plays a pivotal role in the inflammatory response during cytokine storm syndromes. Our aim was to analyze the efficacy and safety of early anti-inflammatory treatment (AIT) with intravenous anakinra with or without glucocorticoids in coronavirus disease 2019 (COVID-19) pneumonia. We performed a retrospective single-center cohort study of patients admitted for COVID-19 pneumonia from February 26 to April 29, 2020, to assess the efficacy of early AIT with intravenous anakinra (100 mg every 8 hours for 3 days, with tapering) alone or in combination with a glucocorticoid (intravenous methylprednisolone, 1-2 mg/kg daily, with tapering). The standard of care (SOC) treatment was hydroxychloroquine and/or azithromycin with or without antivirals and anticoagulants. Late rescue AIT with anakinra or tocilizumab was also evaluated. Treatment effect on overall survival was assessed by a propensity score–adjusted Cox model. A total of 128 patients were analyzed; 63 patients received early AIT (30 received anakinra alone and 33 received anakinra plus a glucocorticoid) at admission, and 65 patients did not receive early AIT and were used as controls; of the latter 65 patients, 44 received the SOC treatment alone and 21 received the SOC treatment plus late rescue AIT. After adjustment for all the unbalanced baseline covariates, early AIT reduced the hazard of mortality by 74% (adjusted hazard ratio [HR] = 0.26; P < .001). The effect was similar in patients receiving anakinra alone (adjusted HR = 0.28; P = .04) and anakinra plus a glucocorticoid (adjusted HR = 0.33; P = .07). Late rescue treatment did not show a significant advantage over SOC treatment alone (adjusted HR = 0.82; P = .70). This study suggests, on a larger series of patients with COVID-19 pneumonia, the potential efficacy and safety of the early use of high doses of intravenous anakinra with or without glucocorticoids.
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Interleukin-1家族：回到未来。
影响因子：
32.4
作者：
Garlanda C;Dinarello CA;Mantovani A
通讯作者：
Mantovani A
DOI：
10.1016/j.jaci.2020.11.006
发表时间：
2021-03
期刊：
The Journal of allergy and clinical immunology
影响因子：
--
作者：
Bozzi G;Mangioni D;Minoia F;Aliberti S;Grasselli G;Barbetta L;Castelli V;Palomba E;Alagna L;Lombardi A;Ungaro R;Agostoni C;Baldini M;Blasi F;Cesari M;Costantino G;Fracanzani AL;Montano N;Monzani V;Pesenti A;Peyvandi F;Sottocorno M;Muscatello A;Filocamo G;Gori A;Bandera A
通讯作者：
Bandera A
影响因子：
8.4
作者：
Langer-Gould, Annette;Smith, Jessica B.;Gould, Michael K.
通讯作者：
Gould, Michael K.
DOI：
10.1056/nejmoa1407222
发表时间：
2014-10-16
期刊：
The New England journal of medicine
影响因子：
--
作者：
Maude SL;Frey N;Shaw PA;Aplenc R;Barrett DM;Bunin NJ;Chew A;Gonzalez VE;Zheng Z;Lacey SF;Mahnke YD;Melenhorst JJ;Rheingold SR;Shen A;Teachey DT;Levine BL;June CH;Porter DL;Grupp SA
通讯作者：
Grupp SA
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.