ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2021 August;87(8):891-902

DOI: 10.23736/S0375-9393.21.15339-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Immunosuppressive strategies in invasively ventilated ARDS COVID-19 patients

Giacomo MONTI ¹, Corrado CAMPOCHIARO ², Alberto ZANGRILLO ^{1, 3}, Anna M. SCANDROGLIO ¹, Evgeny FOMINSKIY ¹, Giulio CAVALLI ^{3, 4}, Giovanni LANDONI ^{1, 3} ✉, Luigi BERETTA ^{1, 3}, Milena MUCCI ¹, Maria G. CALABRÒ ¹, Marina PIERI ¹, Pasquale NARDELLI ¹, Marianna SARTORELLI ¹, Martina BAIARDO REDAELLI ¹, Federica MORSELLI ¹, Ary SERPA NETO ^{5, 6}, Rinaldo BELLOMO ^{5, 7, 8}, Lorenzo DAGNA ^{2, 3} the COVID-BioB Study Group 

¹ Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; ² Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ³ Vita-Salute San Raffaele University, Milan, Italy; ⁴ Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁵ School of Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, Melbourne, Australia; ⁶ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; ⁷ Faculty of Medicine, University of Melbourne, Melbourne, Australia; ⁸ Department of Intensive Care, Austin Hospital, Melbourne, Australia

BACKGROUND: COVID-19 is associated with elevated levels of inflammatory cytokines. We present the characteristics and outcomes of patients treated in the Intensive Care Unit (ICU) with immunosuppressive drugs, either tocilizumab or anakinra compared with controls.
METHODS: A single-center observational prospective study on ICU invasively ventilated COVID-19 patients. The primary outcome was the clinical improvement at day 28. A Bayesian framework was employed, and all analyses were adjusted for confounders.
RESULTS: Sixty-one consecutive invasively ventilated patients were included, nine (14.7%) received tocilizumab and 15 (24.6%) received anakinra. Over the first seven days, tocilizumab was associated with a greater decrease in C-reactive protein (P<0.001). After adjusting for confounders, the probability of clinical improvement at day 28 compared to control was 7∙6% (OR=0.36 [95% CrI: 0.09-1.46]) for tocilizumab and 40.9% (OR=0.89 [95% CrI: 0.32-2.43]) for anakinra. At day 28, the probability of being in a better clinical category was 2.5% (OR=2.98 [95% CrI: 1.00-8.88]) for tocilizumab, and 49.5% (OR=1.00 [95% CrI: 0.42-2.42]) for anakinra.
CONCLUSIONS: In invasively ventilated COVID-19 patients, treatment with anakinra was associated with a higher probability of clinical improvement compared to tocilizumab; however, treatment with either drug did not result in clinically meaningful improvements compared with controls.

KEY WORDS: COVID-19; Tocilizumab; Respiration, artificial; Intensive Care Units; Critical care