About: Early Identification of COVID-19 Cytokine Storm and Treatment with Anakinra or Tocilizumab

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About: Early Identification of COVID-19 Cytokine Storm and Treatment with Anakinra or Tocilizumab Goto Sponge NotDistinct Permalink

An Entity of Type : schema:ScholarlyArticle, within Data Space : wasabi.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Early Identification of COVID-19 Cytokine Storm and Treatment with Anakinra or Tocilizumab
Creator	Permanente, Kaiser Castillo, Rhina Gonzales, Edlin Gould, Michael Langer-Gould, Annette Li, Bonnie Ramanathan, Anusha Smith, Jessica Figueroa, Judith Tyson, Bernard
source	Elsevier; Medline; PMC
abstract	OBJECTIVE: To examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). METHODS: We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from the electronic health record. RESULTS: At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only 7 (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated). Patients who died had more severe sepsis and respiratory failure and met COVID-CS laboratory criteria longer (median = 3 days) compared to those extubated/never intubated (median = 1 day). After accounting for differences in disease severity at treatment initiation, this apparent superiority of anakinra over tocilizumab was no longer statistically significant (propensity score-adjusted hazards ratio 0.46, 95% confidence interval 0.18–1.20). CONCLUSIONS: Prompt identification and treatment of COVID19-CS prior to intubation may be more important than the specific type of anti-inflammatory treatment. Randomized controlled trials of targeted anti-cytokine treatments and corticosteroids should report duration of cytokine storm in addition to clinical severity at randomization.
has issue date	2020-08-06(xsd:dateTime)
bibo:doi	10.1016/j.ijid.2020.07.081
bibo:pmid	32768693
has license	no-cc
sha1sum (hex)	5cf02ff4e36940f1423c106d0c87238b16de818d
schema:url	https://doi.org/10.1016/j.ijid.2020.07.081
resource representing a document's title	Early Identification of COVID-19 Cytokine Storm and Treatment with Anakinra or Tocilizumab
has PubMed Central identifier	PMC7406519
has PubMed identifier	32768693
schema:publication	Int J Infect Dis
resource representing a document's body	covid:5cf02ff4e36940f1423c106d0c87238b16de818d#body_text
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