Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
Front Immunol. 2023 May 26;14:1185716. doi: 10.3389/fimmu.2023.1185716. eCollection 2023.
Tocilizumab and anakinra are anti-interleukin drugs to treat severe coronavirus disease 2019 (COVID-19) refractory to corticosteroids. However, no studies compared the efficacy of tocilizumab versus anakinra to guide the choice of the therapy in clinical practice. We aimed to compare the outcomes of COVID-19 patients treated with tocilizumab or anakinra.
Our retrospective study was conducted in three French university hospitals between February 2021 and February 2022 and included all the consecutive hospitalized patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection assessed by RT-PCR who were treated with tocilizumab or anakinra. A propensity score matching was performed to minimize confounding effects due to the non-random allocation.
Among 235 patients (mean age, 72 years; 60.9% of male patients), the 28-day mortality (29.4% 31.2%, p = 0.76), the in-hospital mortality (31.7% 33.0%, p = 0.83), the high-flow oxygen requirement (17.5% 18.3%, p = 0.86), the intensive care unit admission rate (30.8% 22.2%, p = 0.30), and the mechanical ventilation rate (15.4% 11.1%, p = 0.50) were similar in patients receiving tocilizumab and those receiving anakinra. After propensity score matching, the 28-day mortality (29.1% 30.4%, p = 1) and the rate of high-flow oxygen requirement (10.1% 21.5%, p = 0.081) did not differ between patients receiving tocilizumab or anakinra. Secondary infection rates were similar between the tocilizumab and anakinra groups (6.3% 9.2%, p = 0.44).
Our study showed comparable efficacy and safety profiles of tocilizumab and anakinra to treat severe COVID-19.
托珠单抗和阿那白滞素是治疗皮质类固醇难治性严重 2019 冠状病毒病（COVID-19）的抗白细胞介素药物。然而，尚无研究比较托珠单抗与阿那白滞素的疗效，以指导临床实践中的治疗选择。我们旨在比较接受托珠单抗或阿那白滞素治疗的 COVID-19 患者的结局。
我们的回顾性研究在 2021 年 2 月至 2022 年 2 月期间在法国的三家大学医院进行，纳入了所有经实验室确诊为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染并接受 RT-PCR 评估的连续住院患者，这些患者接受了托珠单抗或阿那白滞素治疗。进行倾向评分匹配以最小化由于非随机分配而导致的混杂效应。
在 235 名患者（平均年龄 72 岁；60.9%为男性）中，28 天死亡率（29.4%和 31.2%，p=0.76）、住院死亡率（31.7%和 33.0%，p=0.83）、高流量氧气需求（17.5%和 18.3%，p=0.86）、入住重症监护病房率（30.8%和 22.2%，p=0.30）和机械通气率（15.4%和 11.1%，p=0.50）在接受托珠单抗和阿那白滞素治疗的患者中相似。在进行倾向评分匹配后，接受托珠单抗或阿那白滞素治疗的患者的 28 天死亡率（29.1%和 30.4%，p=1）和高流量氧气需求率（10.1%和 21.5%，p=0.081）没有差异。托珠单抗组和阿那白滞素组的继发感染率相似（6.3%和 9.2%，p=0.44）。
我们的研究表明，托珠单抗和阿那白滞素治疗严重 COVID-19 的疗效和安全性相似。
