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Randomized Controlled Trial
. 2023 Mar-Apr;30(2):e108-e116.
doi: 10.1097/MJT.0000000000001603. Epub 2023 Feb 22.

Anakinra-An Interleukin-1 Receptor Antagonist for COVID-19

Timothy Nguyen  1 , Lorena Dima  2 , Kristine C Willett  3
Affiliations
Randomized Controlled Trial

Anakinra-An Interleukin-1 Receptor Antagonist for COVID-19

Timothy Nguyen et al. Am J Ther. 2023 Mar-Apr.

Abstract

Background: Coronavirus disease (COVID-19) caused by SARS-CoV-2 virus caused a global pandemic in 2019. There are limited pharmacologic options available. The Food and Drug Administration initiated an emergency use authorization process to expedite pharmacologic agents to treat COVID-19. There are several agents available through the emergency use authorization process, ritonavir-boosted nirmatrelvir, remdesivir, and baricitinib. Anakinra is an interleukin (IL)-1 receptor antagonist that exhibits properties in fighting against COVID-19.

Mechanism of action, pharmacodynamics, and pharmacokinetics: Anakinra is a recombinant IL-1 receptor antagonist. The epithelial cell damage that may occur with COVID-19 enhances the release of IL-1, which plays a central role in severe cases. Thus, drugs that inhibit the IL-1 receptor may be beneficial in the management of COVID-19. Anakinra has good bioavailability after subcutaneous injection and a half-life of up to 6 hours.

Clinical trials: The SAVE-MORE, double-blind, randomized controlled trial, phase 3 evaluated the efficacy and safety of anakinra. Anakinra 100 mg was given subcutaneously daily for up to 10 days in patients with moderate and severe COVID-19 and plasma suPAR ≥6 ng/mL. Anakinra group had a 50.4% fully recovered with no viral RNA detected on day 28 versus 26.5% for placebo, and more than 50% of relative decrease in mortality. A significantly decreased risk of worse clinical outcome was observed.

Therapeutic advance: COVID-19 causes global pandemic and a serious viral disease. There are limited therapy options to combat this deadly disease. Anakinra is an IL-1 receptor antagonist and shown to be effective for the treatment of COVID-19 in some trials but not others. Anakinra, the first in this class, seems to have a mix result for the treatment of COVID-19.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

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