Letter to the Editor
Anakinra as a potential alternative in the treatment of severe acute respiratory infection associated with SARS-CoV-2 refractory to tocilizumab: comment
Anakinra, una alternativa potencial en el tratamiento de la infección respiratoria grave por SARS-CoV-2 refractaria a tocilizumab: comentario
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Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "120" "paginaFinal" => "121" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ismael Francisco Aomar-Millán, Juan Salvatierra, José Luis Callejas-Rubio, Enrique Raya-Álvarez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ismael Francisco" "apellidos" => "Aomar-Millán" "email" => array:1 [ 0 => "iaomarmillan@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan" "apellidos" => "Salvatierra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José Luis" "apellidos" => "Callejas-Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Enrique" "apellidos" => "Raya-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario San Cecilio, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Anakinra, una alternativa potencial en el tratamiento de la infección respiratoria grave por SARS-CoV-2 refractaria a tocilizumab: comentario" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Figuero-Pérez et al. published in the last issue of your journal suggesting the usefulness of anakinra in severe respiratory SARS-CoV-2 infection refractory to tocilizumab<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and would like to make some observations.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical course of SARS-CoV-2 infection has three distinct clinical phases<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. In the initial phase there is viral replication with flu-like symptoms and then some patients progress, between day 6 and 13 of symptom onset, to a hyperinflammatory phase with the development of pneumonia that may progress to respiratory distress syndrome.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathogenesis of severe SARS-CoV-2 infection involves dysregulation of the immune response with lymphopenia, increased pro-inflammatory cytokines (IL-1, IL-2, IL-6, IL-7 or TNF alpha) and a decrease in gamma-interferon. This leads to a systemic inflammatory syndrome with elevated acute phase reactants such as C-reactive protein and ferritin<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment of this inflammatory phase with drugs such as dexamethasone or tocilizumab has been shown to reduce mortality<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Anakinra, an IL-1 receptor antagonist, has recently obtained EMA approval for treatment in adult patients with COVID-19 pneumonia and risk of progression to severe respiratory failure based on the SAVE MORE clinical trial which demonstrated a reduction in 28-day mortality and hospital stay in those treated early with anakinra<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is little evidence regarding rescue therapy in patients with poor clinical outcome despite corticosteroids and/or immunomodulators. In an article published by our group<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>, we analysed 143 patients with moderate/severe SARS-CoV-2 pneumonia and hyperinflammation treated with various regimens based on the protocols of that date. We observed that in those who had not responded to corticosteroids with or without tocilizumab, treatment with anakinra could be a useful alternative. Our patients received 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h on day 1 if they weighed between 50 and 60<span class="elsevierStyleHsp" style=""></span>kg, 100<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h between 60 and 75<span class="elsevierStyleHsp" style=""></span>kg or 100<span class="elsevierStyleHsp" style=""></span>mg/6<span class="elsevierStyleHsp" style=""></span>h if they weighed >75<span class="elsevierStyleHsp" style=""></span>kg. Subsequently all received 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h from day 2 to day 6. After adjustment for age and clinical severity indices, anakinra administration was associated with a reduced risk of mortality (HR; .518, 95% CI .265–.910, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0437).</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case published by Figuero-Pérez et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> we consider that it cannot be suggested that the patient's clinical improvement was due to anakinra when a single dose of 100<span class="elsevierStyleHsp" style=""></span>mg was administered. Given that the half-life of anakinra is 4−6<span class="elsevierStyleHsp" style=""></span>h and that of tocilizumab around 6 days, it is likely that the patient’s improvement was due to the effect of tocilizumab. There is currently no consensus on the optimal doses of anakinra in this clinical setting, but higher and longer doses have been used in the literature<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-01-05" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aomar-Millán IF, Salvatierra J, Callejas-Rubio JL, Raya-Álvarez E. Anakinra, una alternativa potencial en el tratamiento de la infección respiratoria grave por SARS-CoV-2 refractaria a tocilizumab: comentario. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 27 | 16 | 43 |
| 2024 September | 53 | 24 | 77 |
| 2024 August | 66 | 35 | 101 |
| 2024 July | 60 | 37 | 97 |
| 2024 June | 71 | 29 | 100 |
| 2024 May | 72 | 26 | 98 |
| 2024 April | 82 | 23 | 105 |
| 2024 March | 3392 | 32 | 3424 |
| 2024 February | 62 | 28 | 90 |
| 2024 January | 53 | 26 | 79 |
| 2023 December | 51 | 29 | 80 |
| 2023 November | 51 | 32 | 83 |
| 2023 October | 38 | 30 | 68 |
| 2023 September | 65 | 43 | 108 |
| 2023 August | 80 | 23 | 103 |
| 2023 March | 5 | 5 | 10 |
| 2022 August | 1 | 0 | 1 |
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