Treatment of cytokine storm syndrome with IL‐1 receptor antagonist anakinra in a patient with ARDS caused by COVID‐19 infection: A case report

Abstract

Cytokine storm syndrome (CSS) represents a severe complication in COVID-19. Anakinra, an Il-1 receptor antagonist, may orchestrate the excessive inflammation. We report the use of anakinra (100 mg/d) in COVID-19. Under therapy, clinical stabilization occurred. After discontinuation of the biological, bacterial superinfection with sepsis occurred. On December 31, 2019, the number of hospitalized patients with severe pneumonia suddenly increased in the Chinese city of Wuhan (Hubei Province). Soon after the first cases, on January 7, 2019, Chinese health authorities reported that the outbreak was caused by a novel coronavirus, named coronavirus SARS-CoV-2. 1 Epidemiologic data indicated that person-to-person transmission of SARS-CoV-2 was occurring, and the resulting disease was named coronavirus Disease 2019 (COVID-19). 1 Despite rigid containment and

Current evidence on the use of anakinra in COVID-19

“…Published studies are mostly observational that investigate the safety and efficacy of anakinra alone or combined with other medications. Several case reports of patients with severe disease and COVID-19-related complications, such as ARDS, pericarditis, or myocarditis, who were successfully treated with anakinra are summarized in table 2 [18] , [19] , [20] , [21] , [22] , [23] .…”

Therapeutic role of immunomodulators during the COVID-19 pandemic– a narrative review

“…Evidence points toward anakinra not being inferior to tocilizumab, and being a potential alternative for patients in which tocilizumab cannot be used [ 137 , 138 ]. In severe COVID-19, reports suggest the role of anakinra in the safe management of the cytokine storm syndrome [ 139 , 140 ], albeit with potential risks, such as sepsis [ 141 ]. Data seem to consistently show the ability of anakinra to alleviate hyperinflammation in critical COVID-19 cases, with reported effects on CD4 count [ 136 ], fever, ferritin plasma levels, as well as other clinical parameters [ 142 , 143 ] and inflammatory markers [ 144 , 145 ].…”

A Prospective Cohort Study of COVID-19: Evaluation of the Early Role of IL-1 and IL-6 Antagonists in Improving the Outcome of the Illness and Reduction in the Risk of Death

“…IL-1 is a proinflammatory cytokine that plays an important role in the immune system’s response to infection and tissue injury. It is produced by a variety of immune cells, including macrophages, monocytes, and dendritic cells, and acts to recruit and activate other immune cells [ 30 , 40 , 41 ]. IL-1 has been implicated in the pathogenesis of many inflammatory and autoimmune diseases, including rheumatoid arthritis, gout, and systemic juvenile idiopathic arthritis [ 40 , 42 , 43 ].…”

“…It is produced by a variety of immune cells, including macrophages, monocytes, and dendritic cells, and acts to recruit and activate other immune cells [ 30 , 40 , 41 ]. IL-1 has been implicated in the pathogenesis of many inflammatory and autoimmune diseases, including rheumatoid arthritis, gout, and systemic juvenile idiopathic arthritis [ 40 , 42 , 43 ]. IL-6 is involved in a wide range of immune responses in the body and is produced by a variety of immune cells, including T cells, B cells, macrophages, and fibroblasts [ 31 , 42 ].…”

“…As a result, blocking the activity of IL-1 and IL-6 has been proposed as a potential therapeutic strategy for the treatment of COVID-19 [ 35 , 38 , 45 ]. IL-1 receptor antagonist, anakinra, has been used to treat a variety of inflammatory disorders, including rheumatoid arthritis and psoriasis, and is being tested for its potential to treat COVID-19 [ 30 , 38 , 40 , 42 ]. IL-6 antagonist, tocilizumab, is a monoclonal antibody that binds to and neutralizes IL-6 [ 42 , 46 ].…”