tetano
Editor, Senior Moderator
Int J Infect Dis
. 2022 Nov 17;S1201-9712(22)00603-8.
doi: 10.1016/j.ijid.2022.11.017. Online ahead of print.
Anakinra or high-dose corticosteroids in COVID-19 pneumonia patients who deteriorate on low-dose dexamethasone: An observational study of comparative effectiveness
Annette Langer-Gould[SUP] 1 [/SUP], Stanley Xu[SUP] 2 [/SUP], Laura C Myers[SUP] 3 [/SUP], Aiyu Chen[SUP] 2 [/SUP], John D Greene[SUP] 3 [/SUP], Beth Creekmur[SUP] 2 [/SUP], Katia Bruxvoort[SUP] 2 [/SUP], John L Adams[SUP] 4 [/SUP], Vincent Liu[SUP] 3 [/SUP], Michael K Gould[SUP] 5 [/SUP]
Affiliations
Abstract
Objective: To assess whether escalating to high-dose corticosteroids or anakinra compared to continuing low-dose corticosteroids reduced mortality in patients with severe coronavirus disease 2019 (COVID-19) whose respiratory function deteriorated while receiving dexamethasone 6mg daily (DEXA6).
Methods: We conducted a retrospective cohort study between 3/1-12/31/2020 of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone >10mg daily) or remaining on low-dose corticosteroids on the day of first respiratory deterioration.
Results: We analyzed 6,671 patients whose respiratory status deteriorated while receiving DEXA6 for COVID-19 pneumonia, of whom 6265 stayed on low-dose corticosteroids, 232 were escalated to high-dose corticosteroids and 174 to anakinra in addition to corticosteroids. The propensity score-adjusted odds of death were higher in the anakinra (odds ratio [OR]=1.76, 95% CI=1.13-2.72) and high-dose corticosteroid groups (OR=1.53, 95% CI=1.14-2.07) compared with those who continued low-dose corticosteroids on the day of respiratory deterioration. The odds of hospital-acquired infections were also higher in the anakinra (OR=2.00, 95% CI=1.28-3.11) and high-dose corticosteroid groups (OR=1.43, 95% CI=1.00-2.04) compared with low-dose corticosteroid group.
Conclusion: Our findings do not support escalating patients with COVID-19 pneumonia who deteriorate on low-dose corticosteroids to high-dose corticosteroids or anakinra.
Keywords: COVID-19; anakinra; corticosteroids; infections; mortality.
. 2022 Nov 17;S1201-9712(22)00603-8.
doi: 10.1016/j.ijid.2022.11.017. Online ahead of print.
Anakinra or high-dose corticosteroids in COVID-19 pneumonia patients who deteriorate on low-dose dexamethasone: An observational study of comparative effectiveness
Annette Langer-Gould[SUP] 1 [/SUP], Stanley Xu[SUP] 2 [/SUP], Laura C Myers[SUP] 3 [/SUP], Aiyu Chen[SUP] 2 [/SUP], John D Greene[SUP] 3 [/SUP], Beth Creekmur[SUP] 2 [/SUP], Katia Bruxvoort[SUP] 2 [/SUP], John L Adams[SUP] 4 [/SUP], Vincent Liu[SUP] 3 [/SUP], Michael K Gould[SUP] 5 [/SUP]
Affiliations
- PMID: 36403818
- DOI: 10.1016/j.ijid.2022.11.017
Abstract
Objective: To assess whether escalating to high-dose corticosteroids or anakinra compared to continuing low-dose corticosteroids reduced mortality in patients with severe coronavirus disease 2019 (COVID-19) whose respiratory function deteriorated while receiving dexamethasone 6mg daily (DEXA6).
Methods: We conducted a retrospective cohort study between 3/1-12/31/2020 of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone >10mg daily) or remaining on low-dose corticosteroids on the day of first respiratory deterioration.
Results: We analyzed 6,671 patients whose respiratory status deteriorated while receiving DEXA6 for COVID-19 pneumonia, of whom 6265 stayed on low-dose corticosteroids, 232 were escalated to high-dose corticosteroids and 174 to anakinra in addition to corticosteroids. The propensity score-adjusted odds of death were higher in the anakinra (odds ratio [OR]=1.76, 95% CI=1.13-2.72) and high-dose corticosteroid groups (OR=1.53, 95% CI=1.14-2.07) compared with those who continued low-dose corticosteroids on the day of respiratory deterioration. The odds of hospital-acquired infections were also higher in the anakinra (OR=2.00, 95% CI=1.28-3.11) and high-dose corticosteroid groups (OR=1.43, 95% CI=1.00-2.04) compared with low-dose corticosteroid group.
Conclusion: Our findings do not support escalating patients with COVID-19 pneumonia who deteriorate on low-dose corticosteroids to high-dose corticosteroids or anakinra.
Keywords: COVID-19; anakinra; corticosteroids; infections; mortality.