TY - JOUR
TI - Favorable Anakinra Responses in Severe Covid-19 Patients with Secondary Hemophagocytic Lymphohistiocytosis
AU - Dimopoulos, G.
AU - de Mast, Q.
AU - Markou, N.
AU - Theodorakopoulou, M.
AU - Komnos, A.
AU - Mouktaroudi, M.
AU - Netea, M.G.
AU - Spyridopoulos, T.
AU - Verheggen, R.J.
AU - Hoogerwerf, J.
AU - Lachana, A.
AU - van de Veerdonk, F.L.
AU - Giamarellos-Bourboulis, E.J.
JO - Cell Host and Microbe
PY - 2020
VL - 28
TODO - 1
SP - 117-123.e1
PB - Cell Press
SN - null
TODO - 10.1016/j.chom.2020.05.007
TODO - aminotransferase;  anakinra;  azithromycin;  ferritin;  hydroxychloroquine;  hypertensive factor;  interleukin 1 receptor blocking agent;  oxygen, acute kidney failure;  adult;  aged;  Article;  artificial ventilation;  blood culture;  clinical article;  comorbidity;  coronavirus disease 2019;  deterioration;  disease severity;  ferritin blood level;  Greece;  hemophagocytic syndrome;  hemophagocytosis score;  hepatobiliary disease;  hospitalization;  human;  intensive care unit;  lung infiltrate;  male;  middle aged;  Netherlands;  oxygen consumption;  pancytopenia;  polymerase chain reaction;  priority journal;  respiratory failure;  respiratory function;  scoring system;  sepsis;  survival time;  thorax radiography;  treatment response;  very elderly;  virus pneumonia;  Betacoronavirus;  blood;  complication;  Coronavirus infection;  female;  hemophagocytic syndrome;  off label drug use;  pandemic;  respiratory failure;  virus pneumonia, Aged;  Aged, 80 and over;  Betacoronavirus;  Comorbidity;  Coronavirus Infections;  Female;  Humans;  Interleukin 1 Receptor Antagonist Protein;  Lymphohistiocytosis, Hemophagocytic;  Male;  Middle Aged;  Off-Label Use;  Oxygen;  Pandemics;  Pneumonia, Viral;  Respiratory Insufficiency
TODO - Complex immune dysregulation in severe COVID-19 suggests the use of immunomodulation therapies. Dimopoulos et al. describe eight cases of COVID-19 patients who all had secondary hemophagocytic lymphohistiocytosis and showed favorable responses in respiratory function upon treatment with the interleukin-1 receptor antagonist Anakinra. © 2020 Elsevier Inc.
Dysregulation of inflammation is hypothesized to play a crucial role in the severe complications of COVID-19, with the IL-1/IL-6 pathway being central. Here, we report on the treatment of eight severe COVID-19 pneumonia patients—seven hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands—with the interleukin-1 receptor antagonist Anakinra. All patients scored positive for the hemophagocytosis score (HScore) and were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH) characterized by pancytopenia, hyper-coagulation, acute kidney injury, and hepatobiliary dysfunction. At the end of treatment, ICU patients had less need for vasopressors, significantly improved respiratory function, and lower HScore. Although three patients died, the mortality was lower than historical series of patients with sHLH in sepsis. These data suggest that administration of Anakinra may be beneficial for treating severe COVID-19 patients with sHLH as determined by the HScore, and they support the need for larger clinical studies to validate this concept. © 2020 Elsevier Inc.
ER -