medwireNews : The US FDA has issued an Emergency Use Authorization permitting use of the interleukin (IL)-1 receptor antagonist anakinra to treat certain hospitalized patients with severe COVID-19.

Anakinra is currently approved in the European Union for the treatment of rheumatoid arthritis, Still’s disease, familial Mediterranean fever, and cryopyrin-associated periodic syndromes.

Early anakinra treatment may reduce the risk for poor outcomes in patients with COVID-19 who are at risk for progressing to respiratory failure on the basis of elevated soluble urokinase plasminogen activator receptor levels, SAVE-MORE trial data show.

Treatment with the IL-1 receptor antagonist anakinra may reduce mortality risk versus standard care in people with moderate-to-severe COVID-19, particularly those with hyperinflammation, suggests a systematic review and patient-level meta-analysis.

Treatment with the interleukin-1 receptor antagonist anakinra may reduce the risk for poor outcomes among people with severe COVID-19, suggest findings from the Ana-COVID study.

Preliminary results from two studies suggest that the IL-1 receptor antagonist anakinra may warrant further investigation for the treatment of COVID-19.

Preliminary findings from a US retrospective case series suggest that early treatment with the IL-1 receptor antagonist anakinra may be a promising strategy for COVID-19 patients with acute hypoxic respiratory failure and symptoms of cytokine storm syndrome.

Phase 2 study anaGO findings presented in a poster at the EULAR 2020 E-congress reveal that patients with difficult-to-treat gout who receive the interleukin-1 receptor antagonist anakinra report comparable levels of pain reduction to those given triamcinolone.

The interleukin-1 receptor inhibitor anakinra merits further investigation for the treatment of Kawasaki disease, suggest findings from a phase IIa trial presented at the EULAR 2019 congress in Madrid, Spain.

Findings from a randomized trial suggest that treatment with the interleukin-1 receptor antagonist anakinra is noninferior to usual care for the treatment of gout flares.

The EMA has recommended expanding the indication of anakinra to include systemic juvenile idiopathic arthritis and adult-onset Still’s disease.

Kearsley-Fleet L et al. Rheumatology (Oxford) 2018: key262. doi: 10.1093/rheumatology/key262

The only significant difference between the two time periods was that the median length of hospital stay was longer during the first wave than during the delta wave (8.0 vs 5.0 days), which the team suggests “might partly be explained by prompt use of steroids and anakinra in complicated cases” during delta.

The commentators caution that given the limitations of the study – including few longitudinal samples and incomplete mechanistic evaluation – the findings “should neither affect clinical decision making, nor favour an expanded front-line use of anakinra (recombinant IL-1Ra) in patients with MIS-C, particularly given the complete response of most patients to IVIG and glucocorticoids.” medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group 14 April 2022: The coronavirus pandemic is affecting all healthcare professionals across the globe.

Most patients (90.3%) received treatment directly preceding canakinumab initiation (etanercept 27.7%; anakinra 18.5%; adalimumab 16.9%); the respective treatment was discontinued due to lack of efficacy/effectiveness (43.1%) and availability of a new treatment (27.8%).

They also observed similar findings in a small group of individuals with Kawasaki disease and a suspected delayed reaction to anakinra.

However, there was insufficient evidence to recommend the use of other immunomodulatory drugs, including interferon inhibitors, leflunomide, or cyclosporin, and they say that further research into biomarker-based stratification is needed for interleukin-1 inhibitors such as anakinra.

The efficacy of anakinra in treating CCPD was not obvious.

“Early during the pandemic and at the time of study design, the results of case-control studies with the IL-1 blocker anakinra further supported this hypothesis,” they add.

A total of 16% received treatment with the IL-1 receptor inhibitor anakinra, while 14% were given an IL-6 receptor inhibitor (tocilizumab or sarilumab), and the remaining 70% did not receive IL inhibitors and formed the control group.