본문 바로가기
KERD
논문KCI 등재

The Safety and Efficacy of Anakinra, an Interleukin-1 Antagonist in Severe Cases of COVID-19: A Systematic Review and Meta-Analysis

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류내과학

초록

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

Abstract

This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease 2019 (COVID-19). Numerous electronic databases were searched and finally 15 studies with a total of 3,530 patients, 757 in the anakinra arm, 1,685 in the control arm were included. The pooled adjusted odds ratio (OR) for mortality in the treatment arm was 0.34 (95% confidence interval [CI], 0.21 - 0.54, I2 = 48%), indicating a significant association between anakinra and mortality. A significant association was found regarding mechanical ventilation requirements in anakinra group compared to the control group OR, 0.68 (95% CI, 0.49 - 0.95, I2 = 50%). For the safety of anakinra, we evaluated thromboembolism risk and liver transaminases elevation. Thromboembolism risk was OR, 1.59 (95% CI, 0.65 - 3.91, I2 = 0%) and elevation in liver transaminases with OR was 1.35 (95% CI, 0.61 - 3.03, I2 = 76%). Both were not statistically significant over the control group. Anakinra is beneficial in lowering mortality in COVID-19 patients. However, these non-significant differences in the safety profile between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

참고문헌 (35)

  1. Vizcarra P, "Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort", Lancet HIV, 7, pp.e554~e564 (2020)
  2. "COVID data tracker"[URL]
  3. "COVID-19. Healthcare workers: Information for clinicians on investigational therapeutics for patients with COVID-19"[URL]
  4. Wormser GP, "Fields Virology", Clin Infect Dis, 34, pp.1029~1030 (2002)
  5. Esakandari H, "A comprehensive review of COVID-19 characteristics", Biol Proced Online, 22, pp.19~ (2020)
  6. Ballet JJ, "Separation of precursor T cells and Ig-secreting B cells from the large lymphocytic cells of human tonsil", Cell Immunol, 33, pp.291~296 (1977)
  7. Mehta P, "COVID-19: consider cytokine storm syndromes and immunosuppression", Lancet, 395, pp.1033~1034 (2020)
  8. Fardet L, "Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome", Arthritis Rheumatol, 66, pp.2613~2620 (2014)
  9. Huet T, "Anakinra for severe forms of COVID-19: a cohort study", Lancet Rheumatol, 2, pp.e393~e400 (2020)
  10. Cauchois R, "Early IL-1 receptor blockade in severe inflammatory respiratory failure complicating COVID-19", Proc Natl Acad Sci U S A, 117, pp.18951~18953 (2020)
  11. CORIMUNO-19 Collaborative group, "Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial", Lancet Respir Med, 9, pp.295~304 (2021)
  12. Cavalli G, ". Interleukin-1 blockade with highdose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study", Lancet Rheumatol, 2, pp.e325~e331 (2020)
  13. Bozzi G, "Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study", J Allergy Clin Immunol, 147, pp.561~566.e4 (2021)
  14. Narain S, "Comparative survival analysis of immunomodulatory therapy for coronavirus disease 2019 cytokine storm", Chest, 159, pp.933~948 (2021)
  15. Navarro-Millán I, "Use of anakinra to prevent mechanical ventilation in severe COVID-19: a case series", Arthritis Rheumatol, 72, pp.1990~1997 (2020)
  16. Dimopoulos G, "Favorable anakinra responses in severe Covid-19 patients with secondary hemophagocytic lymphohistiocytosis", Cell Host Microbe, 28, pp.117~123.e1 (2020)
  17. Day JW, "Interleukin-1 blockade with anakinra in acute leukaemia patients with severe COVID-19 pneumonia appears safe and may result in clinical improvement", Br J Haematol, 190, pp.e80~e83 (2020)
  18. Aouba A, "Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series", Ann Rheum Dis, 79, pp.1381~1382 (2020)
  19. Pontali E, "Safety and efficacy of early highdose IV anakinra in severe COVID-19 lung disease", J Allergy Clin Immunol, 146, pp.213~215 (2020)
  20. Zhang B, "Clinical characteristics of 82 cases of death from COVID-19", PLoS One, 15, pp.e0235458~ (2020)
  21. Sarfraz A, "Therapeutic plasma exchange and COVID-19: a rapid review", J Clin Immunol Immunother, 6, pp.041~ (2020)
  22. Li X, "Molecular immune pathogenesis and diagnosis of COVID-19", J Pharm Anal, 10, pp.102~108 (2020)
  23. Schulte W, "Cytokines in sepsis: potent immunoregulators and potential therapeutic targets--an updated view", Mediators Inflamm, 2013, pp.165974~ (2013)
  24. Channappanavar R, "Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology", Semin Immunopathol, 39, pp.529~539 (2017)
  25. Otsuka R, "Macrophage activation syndrome and COVID-19", Inflamm Regen, 40, pp.19~ (2020)
  26. Conti P, "Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): antiinflammatory strategies", J Biol Regul Homeost Agents, 34, pp.327~331 (2020)
  27. King A, "Anakinra in COVID-19: important considerations for clinical trials", Lancet Rheumatol, 2, pp.e379~e381 (2020)
  28. "Transform how you use drug information. Drug Monograph – Anakinra"[URL]
  29. Schett G, "Interleukin-1 function and role in rheumatic disease", Nat Rev Rheumatol, 12, pp.14~24 (2016)
  30. RECOVERY Collaborative Group, "Dexamethasone in Hospitalized Patients with Covid-19", N Engl J Med, 384, pp.693~704 (2021)
  31. Borie R, "Glucocorticoids with low-dose anti-IL1 anakinra rescue in severe non-ICU COVID-19 infection: a cohort study", PLoS One, 15, pp.e0243961~ (2020)
  32. Aomar-Millán IF, "Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study", Intern Emerg Med, pp.1~10 (2021)
  33. Pasin L, "Anakinra for patients with COVID-19: a meta-analysis of non-randomized cohort studies", Eur J Intern Med, 86, pp.34~40 (2021)
  34. "Brand and other names: Kineret"[URL]
  35. Leverenz DL, "Is the HScore useful in COVID-19?", Lancet, 395, pp.e83~ (2020)

관련 논문AI추천

The effects of remdesivir on mortality and the requirement for mechanical ventilation in patients with COVID-19: a systematic review stratified by disease severityEun-Jeong Joo, Kyungmin Huh, Miyoung Choi, Seungeun Ryoo, Su-Yeon Yu, Young Kyung Yoon대한내과학회 · The Korean Journal of Internal Medicine2024 · 제39권 제1호Ruxolitinib and the Mitigation of Severe COVID-19: A Systematic Review and Meta-analysisAbdulhusein Kapasi, Abubakar Gapizov, Adrian Riva-Moscoso, Azza Sarfraz, Donald Hathaway, Fortunato S Príncipe-Meneses, Jennifer Ross-Comptis, Jorge R. Quiros, Kimberly Anne Romero, Manoj Reddy Somagutta, Zhanna Grigoryan, Zouina Sarfraz대한감염학회 · Infection and Chemotherapy2021 · 제53권 제3호Hyper-inflammatory responses in COVID-19 and anti-inflammatory therapeutic approaches신의철, Hojun Choi생화학분자생물학회 · BMB Reports2022 · 제55권 제1호Biomarkers for Prognosis and Treatment Response in COVID-19 PatientsAgnello Luisa, Bivona Giulia, Ciaccio Marcello대한진단검사의학회 · Annals of Laboratory Medicine2021 · 제41권 제6호Severity-Adjusted Dexamethasone Dosing and Tocilizumab Combination for Severe COVID-19강은숙, 강철인, 고재훈, 박효정, 백경란, 백진양, 서지영, 손유민, 양진영, 이범기, 정두련, 정치량, 조선영, 하소영, 허경민, 허희재, 홍진영, Eliel Nham연세대학교의과대학 · Yonsei Medical Journal2022 · 제63권 제5호Early Hydroxychloroquine Administration for Rapid Severe Acute Respiratory Syndrome Coronavirus 2 EradicationAhn June Hong, Hong Kyung Soo, Hur Jian, Jang Jong Geol, Kim Hong Nam, Lee Jong Ho, Lee Wonhwa대한감염학회 · Infection and Chemotherapy2020 · 제52권 제3호

이 간행물의 다른 논문 (18건)