COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Pasin L, Cavalli G, Navalesi P, et al. Anakinra for patients with COVID-19: a meta-analysis of non-randomized cohort studies. Eur J Intern Med. 2021 Feb 5. pii: S0953-6205(21)00016-9. doi: 10.1016/j.ejim.2021.01.016.

INTRODUCTION: Severe COVID-19 cases have a detrimental hyper-inflammatory host response and different cytokine-blocking biologic agents were explored to improve outcomes. Anakinra blocks the activity of both IL-1a and IL-1ß and is approved for different autoinflammatory disorders, but it is used off-label for conditions characterized by an excess of cytokine production. Several studies on anakinra in COVID-19 patients reported positive effects. We performed a meta-analysis of all published evidence on the use of anakinra in COVID19 to investigate its effect on survival and need for mechanical ventilation.

METHODS: We searched for any study performed on adult patients with acute hypoxemic failure related to 2019-nCoV infection, receiving anakinra versus any comparator. Primary endpoint was mortality at the longest available follow-up. Adverse effects, need for mechanical ventilation and discharge at home with no limitations were also analysed.

RESULTS: Four observational studies involving 184 patients were included. Overall mortality of patients treated with anakinra was significantly lower than mortality in the control group (95% CI 0.14-0.48, p<0.0001). Moreover, patients treated with anakinra had a significantly lower risk of need for mechanical ventilation than controls (95% CI 0.250.74, p=0.002). No difference in adverse events and discharge at home with no limitations was observed. The Trial Sequential Analysis z-cumulative line reached the monitoring boundary for benefit and the required sample size.

CONCLUSIONS: Administration of anakinra in COVID-19 patients was safe and might be associated with reductions in both mortality and need for mechanical ventilation. Randomized clinical trials are warranted to confirm these findings.

Discipline / Specialty Area Score
Intensivist/Critical Care
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Internal Medicine
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Infectious Disease
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Comments from MORE raters

Hospital Doctor/Hospitalists rater

This is observational data only; although, it's intriguing. This needs a follow up trial.

Infectious Disease rater

This is another proposed treatment for Covid 19 infection. Meta analysis provides a better perspective, but the medication needs to be vetted in various setting for any meaningful action.

Respirology/Pulmonology rater

A meta analysis of non randomised cohort studies does not allow a reader to make a judgement about the value of the treatment being studied. There are too many biases that cannot be accounted for. We can only wait for more reliable data to be generated. This may be of interest to those who are planning more definitive studies, but not for the clinician.

Respirology/Pulmonology rater

This is a new and interesting approach to COVID-19 disease.

Respirology/Pulmonology rater

Another useless metanalysis. How is it possible to draw conclusion on 4 (four) observational studies?