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Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series
  1. Achille Aouba1,
  2. Aurelie Baldolli2,
  3. Loïk Geffray3,
  4. Renaud Verdon2,
  5. Emmanuel Bergot4,
  6. Nicolas Martin-Silva1,
  7. Aurélien Justet4
  1. 1 Department of Internal Medicine and Clinical Immunology, CHU Caen, Caen, France
  2. 2 Department of Infectious Diseases, CHU Caen, Caen, France
  3. 3 Department of Internal Medicine and Clinical Immunology, CH Lisieux, Lisieux, France
  4. 4 Department of Pulmonology, CHU Caen, Caen, France
  1. Correspondence to Dr Achille Aouba, Service de Médecine Interne, CHU Caen, 14000 Caen, France; achille.aouba{at}

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a recently discovered coronavirus, is responsible for COVID-19, a newly emerged disease that has become pandemic. SARS-CoV-2 infection leads to direct tissue injury, especially of the lungs, but can also trigger an exaggerated host immune response. Indeed, the pathogeny of proinflammatory cytokine storm is now demonstrated in COVID-19.1 Besides interleukin (IL)-6 blockade,2 we and others1 hypothesised that targeting IL-1 should be a safe and effective approach to avoid mechanic ventilation in patients with moderate to severe COVID-19 pneumonia (P-MSP) hospitalised in a non-intensive care unit (ICU). About one-third of P-MSPs experience acute respiratory distress syndrome and/or ICU admission with a lethality rate of 60.5%.2 3 We observed similar outcomes in our institution and therefore proposed anti-IL-1 blocking by anakinra to nine consecutive P-MSP patients at high risk of worsening who fulfilled the …

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  • Handling editor Josef S Smolen

  • Contributors AA designed the study. All authors equally contributed to data collection and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AA, outside of this work, obtained non-financial support for research in giant cells arteritis with Anakinra from SOBI Phramaceutics, .

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval All patients gave their informed consent and this retrospective study is in accordance with the Helsinki Declaration.

  • Provenance and peer review Not commissioned; externally peer reviewed.