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10.1016/j.jaci.2020.11.006

http://scihub22266oqcxt.onion/10.1016/j.jaci.2020.11.006
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33220354!7674131!33220354
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suck abstract from ncbi


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pmid33220354      J+Allergy+Clin+Immunol 2021 ; 147 (2): 561-566.e4
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  • Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study #MMPMID33220354
  • Bozzi G; Mangioni D; Minoia F; Aliberti S; Grasselli G; Barbetta L; Castelli V; Palomba E; Alagna L; Lombardi A; Ungaro R; Agostoni C; Baldini M; Blasi F; Cesari M; Costantino G; Fracanzani AL; Montano N; Monzani V; Pesenti A; Peyvandi F; Sottocorno M; Muscatello A; Filocamo G; Gori A; Bandera A
  • J Allergy Clin Immunol 2021[Feb]; 147 (2): 561-566.e4 PMID33220354show ga
  • BACKGROUND: Immunomodulants have been proposed to mitigate severe acute respiratory syndrome coronavirus 2-induced cytokine storm, which drives acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19). OBJECTIVE: We sought to determine efficacy and safety of the association of IL-1 receptor antagonist anakinra plus methylprednisolone in severe COVID-19 pneumonia with hyperinflammation. METHODS: A secondary analysis of prospective observational cohort studies was carried out at an Italian tertiary health care facility. COVID-19 patients consecutively hospitalized (February 25, 2020, to March 30, 2020) with hyperinflammation (ferritin >/=1000 ng/mL and/or C-reactive protein >10 mg/dL) and respiratory failure (oxygen therapy from 0.4 FiO(2) Venturi mask to invasive mechanical ventilation) were evaluated to investigate the effect of high-dose anakinra plus methylprednisolone on survival. Patients were followed from study inclusion to day 28 or death. Crude and adjusted (sex, age, baseline PaO(2):FiO(2) ratio, Charlson index, baseline mechanical ventilation, hospitalization to inclusion lapse) risks were calculated (Cox proportional regression model). RESULTS: A total of 120 COVID-19 patients with hyperinflammation (median age, 62 years; 80.0% males; median PaO(2):FiO(2) ratio, 151; 32.5% on mechanical ventilation) were evaluated. Of these, 65 were treated with anakinra and methylprednisolone and 55 were untreated historical controls. At 28 days, mortality was 13.9% in treated patients and 35.6% in controls (Kaplan-Meier plots, P = .005). Unadjusted and adjusted risk of death was significantly lower for treated patients compared with controls (hazard ratio, 0.33, 95% CI, 0.15-0.74, P = .007, and HR, 0.18, 95% CI, 0.07-0.50, P = .001, respectively). No significant differences in bloodstream infections or laboratory alterations were registered. CONCLUSIONS: Treatment with anakinra plus methylprednisolone may be a valid therapeutic option in COVID-19 patients with hyperinflammation and respiratory failure, also on mechanical ventilation. Randomized controlled trials including the use of either agent alone are needed to confirm these results.
  • |*COVID-19 Drug Treatment[MESH]
  • |*SARS-CoV-2[MESH]
  • |Aged[MESH]
  • |Anti-Inflammatory Agents/*therapeutic use[MESH]
  • |COVID-19/complications/mortality/therapy[MESH]
  • |Cohort Studies[MESH]
  • |Drug Therapy, Combination[MESH]
  • |Female[MESH]
  • |Humans[MESH]
  • |Interleukin 1 Receptor Antagonist Protein/*therapeutic use[MESH]
  • |Male[MESH]
  • |Methylprednisolone/*therapeutic use[MESH]
  • |Middle Aged[MESH]
  • |Pneumonia/*drug therapy/etiology/mortality/therapy[MESH]
  • |Receptors, Interleukin-1/*antagonists & inhibitors[MESH]
  • |Respiration, Artificial[MESH]


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