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suPAR-guided anakinra decreases SRF and restores the pro-/anti-inflammatory balance

Wed Mar 10 2021

An open label trial of anakinra to prevent respiratory failure in COVID-19

The management of pneumonia caused by SARS-CoV-2 should rely on early recognition of the risk for progression to severe respiratory failure (SRF) and its prevention.

The authors investigated if early suPAR -guided anakinra treatment could prevent COVID-19-associated SRF.

30 patients with suPAR ≥6 ng/ml were assigned to subcutaneous anakinra 100mg once daily for 10 days. The primary outcome was SRF incidence by day 14 defined as any respiratory ratio below 150 mmHg necessitating mechanical or non-invasive ventilation. Main secondary outcomes were 30-day mortality and inflammatory mediators; 28-day WHO-CPS was explored. Propensity-matched standard-of-care comparators were studied.

Anakinra treatment of COVID-19 patients admitted with LRTI and suPAR concentrations greater or equal than 6μg/l was associated with a relative decrease of the incidence of SRF by 72%. Anakinra-treated patients who were admitted to the ICU had a shorter stay in the ICU than those who did not receive anakinra. So apparently the benefit of previous anakinra treatment remained. This is also reflected by the overall decrease in 30-day mortality.

Early suPAR-guided anakinra treatment is associated with a decreased risk for SRF and the restoration of the pro- /anti-inflammatory balance.

Kyriazopoulou, E, et al. eLife, 2021

The authors propose a novel strategy using suPAR as an early biomarker that can effectively identify those patients at high risk of SRF.

They conclude that early suPAR-guided anakinra treatment is associated with a decrease of the risk for severe respiratory failure in COVID-19 patients and restoration of the pro- /anti-inflammatory balance.

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