This complimentary article from Hospital Pharmacist’s Letter is being provided to readers of Prescriber’s Letter, who may find its content relevant to their practice.
You’ll hear about anakinra (Kineret) to treat patients admitted with COVID-19...due to a new emergency use authorization.
This IL-1 inhibitor is now authorized for certain adults with SARS-CoV-2 at risk of progressing to severe respiratory failure.
These are patients on low- or high-flow supplemental oxygen...but NOT noninvasive or mechanical ventilation.
Anakinra is dosed 100 mg subcutaneously daily for 10 days.
Explain that a single study suggests anakinra decreases progression to more severe disease and reduces mortality...versus placebo. Most patients were also on dexamethasone and remdesivir.
But other studies with anakinra or the IL-1 inhibitor canakinumab do NOT show improved survival.
Plus anakinra study patients had to have an elevated soluble urokinase plasminogen activator receptor (suPAR) level...a lab marker of inflammation that’s not available in the US.
Because of this, anakinra’s authorization requires meeting 3 of 8 criteria that suggest a patient’s suPAR is high...such as age 75 or older, current or prior smoker, or history of stroke.
Don’t change your COVID-19 protocols to include anakinra yet.
Continue to use the IL-6 inhibitor IV tocilizumab (Actemra)...or the oral Janus kinase (JAK) inhibitor baricitinib (Olumiant)...as your go-to add-on to steroids.
These meds have stronger data showing a mortality benefit...and can also be used in patients needing mechanical ventilation or extracorporeal membrane oxygenation (ECMO).
Continue to turn to the IL-6 inhibitor sarilumab (Kevzara) or the JAK inhibitor tofacitinib (Xeljanz) as alternatives.
Review our resource, Treatments of Interest for COVID-19, for a deeper dive into the evidence.
- https://www.fda.gov/media/163075/download (1-27-23)
- https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/summary-recommendations/ (1-27-23)
- Nat Med. 2021 Oct;27(10):1752-1760
- PLoS One. 2022 Aug 4;17(8):e0269065