• Giacomo Monti, Corrado Campochiaro, Alberto Zangrillo, Anna M Scandroglio, Evgeny Fominskiy, Giulio Cavalli, Giovanni Landoni, Luigi Beretta, Milena Mucci, Maria G Calabrò, Marina Pieri, Pasquale Nardelli, Marianna Sartorelli, Martina Baiardo Redaelli, Federica Morselli, Ary Serpa Neto, Rinaldo Bellomo, Lorenzo Dagna, and COVID-BioB Study Group.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
• Minerva Anestesiol. 2021 Aug 1; 87 (8): 891-902.

BackgroundCOVID-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.MethodsA 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.ResultsSixty-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.ConclusionsIn 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.

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