Via performing a retrospective cohort study of all SARS-coV2-RNA-positive patients managed with the targeted anti-cytokine agents, anakinra or tocilizumab, in Kaiser Permanente Southern California, researchers investigated outcomes among patients with COVID-19 -related cytokine storm (COVID19-CS). At tocilizumab initiation (n = 52), intubation in 50 (96.2%), and concomitant corticosteroids in only 7 (13.5%) were reported. At anakinra initiation (n = 41), intubation in 23 (56.1%), and concomitant corticosteroids in all were reported. Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) relative to those extubated/never intubated (median = 1 day). The apparent superiority of anakinra over tocilizumab remained no longer statistically significant after adjusting for disparities in disease severity at treatment initiation. Findings suggest the higher significance of prompt identification and treatment of COVID19-CS prior to intubation than the specific type of anti-inflammatory treatment. They emphasize reporting duration of cytokine storm in addition to clinical severity at randomization in randomized controlled trials of targeted anti-cytokine treatments and corticosteroids.
Read the full article on International Journal of Infectious Diseases.