Weill Cornell Medicine and Hospital for Special Surgery, New York, New York.
Hospital for Special Surgery, New York, New York.
Arthritis Rheumatol. 2020 Dec;72(12):1990-1997. doi: 10.1002/art.41422. Epub 2020 Nov 4.
To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID-19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure.
To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6-liter nasal cannula or use of ≥95% oxygen by high-flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation.
Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation.
Our data suggest that anakinra could be beneficial in treating COVID-19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID-19 and symptoms of cytokine storm syndrome.
报告使用阿那白滞素预防新型冠状病毒病 2019（COVID-19）、细胞因子风暴综合征症状和急性低氧性呼吸衰竭患者进行机械通气的临床经验。
为纳入本回顾性病例系列研究，患者必须患有严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）、发热、铁蛋白水平＞1000ng/ml 且有 1 项其他实验室炎症标志物升高，以及急性低氧性呼吸衰竭。急性低氧性呼吸衰竭定义为需要通过无重复呼吸面罩补充 15 升氧气，同时使用 6 升鼻导管或通过高流量鼻导管使用≥95%的氧气。我们排除了怀疑有细菌感染或正在接受免疫抑制剂治疗的患者。皮下注射阿那白滞素起始剂量为 100mg，每 6 小时 1 次，并逐渐完全停药。主要结局是预防机械通气。
符合标准的 14 例患者中，11 例患者接受阿那白滞素治疗，最长 19 天。7 例在急性低氧性呼吸衰竭发作后≤36 小时开始阿那白滞素治疗的患者无需机械通气，且均出院回家。4 例在急性低氧性呼吸衰竭发作后≥4 天开始阿那白滞素治疗的患者需要机械通气。其中，3 例患者拔管（2 例出院回家，1 例仍住院），1 例死亡。所有符合标准但未接受阿那白滞素治疗的患者均需要机械通气。2 例患者拔管（1 例出院回家，1 例仍住院），1 例仍在机械通气。
我们的数据表明，在急性低氧性呼吸衰竭发作后早期开始使用阿那白滞素可能对伴有细胞因子风暴综合征证据的 COVID-19 患者有益。我们的患者选择和治疗方法应考虑在临床试验中进行研究，以确定阿那白滞素治疗 COVID-19 和细胞因子风暴综合征症状患者的安全性和疗效。
