de la Calle, CristinaLopez-Medrano, FranciscoPablos, José LuisLora-Tamayo, JaimeMaestro-de la Calle, GuillermoSanchez-Fernandez, MarcosFernandez-Ruiz, MarioPerez-Jacoiste Asin, Maria AsunciónCaro-Teller, Jose ManuelGarcia-Garcia, RocioCatalan, MercedesMartinez-López, JoaquínSevillano, AngelOrigüen, JuliaRipoll, MarSan Juan, RafaelLalueza, Antoniode Miguel, BorjaCarretero, OctavioAguilar, FernandoGómez, CarlosPaz-Artal, EstelaBueno, HectorLumbreras, CarlosAguado, José María2021-10-152021-10-152021-04Int J Infect Dis. 2021; 105:319-3251201-9712http://hdl.handle.net/20.500.12105/13431A subgroup of patients with SARS-CoV-2 infection was thought to have developed cytokine release syndrome and were treated with tocilizumab; however, a significant percentage of patients evolved. This study aimed to determine the usefulness of anakinra as a rescue treatment for patients with tocilizumab-refractory COVID-19 disease. A prospective cohort of patients with COVID-19 pneumonia who received anakinra as salvage therapy after failure of tocilizumab were compared (1:1) with selected controls in a historical cohort of patients treated with tocilizumab. Cases and controls were matched by age, comorbidities, pulse oximetry oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at baseline, and time elapsed since the initiation of treatment with tocilizumab. The primary outcome was the improvement in clinical status measured by a 6-point ordinal scale, from baseline to day 21. The study included 20 cases and 20 controls (mean age 65.3 ± 12.8 years, 65% males). No differences were found in the clinical improvement rates at 7, 14 and 21 days of follow-up. The in-hospital mortality rate for patients receiving anakinra was 55% vs. 45% in the control group (P = 0.527). Treatment with anakinra was not useful in improving the prognosis of patients with tocilizumab-refractory severe COVID-19.engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/SARS-CoV-2AgedAntibodies, Monoclonal, HumanizedCOVID-19Case-Control StudiesCohort StudiesCytokine Release SyndromeFemaleHospital MortalityHumansImmunomodulationInterleukin 1 Receptor Antagonist ProteinMaleMiddle AgedRetrospective StudiesSalvage TherapySpainTreatment FailureTreatment OutcomeAttribution-NonCommercial-NoDerivatives 4.0 Internacional33592340105319-32510.1016/j.ijid.2021.02.0411878-3511International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseasesopen access