Sporadic reports of anakinra use in COVID-19 infection has hinted is potential; now a metanalysis shows that the use of anakinra may reduce the mortality risk in patients admitted to hospital with moderate to severe COVID-19 pneumonia, especially highly elevated ferritin and C-reactive protein (CRP) levels.

This systematic review was narrowed to 9 studies and 1185 patients from nine studies; 8 studies were observational and there was one randomised controlled trial. Most studies were hampered by the use of historical controls.

Metanalysis of patient-level, after multiple adjustments (age, comorbidities, PaO2/FiO2, CRP, lymphopenia), mortality was significantly lower in patients treated with anakinra (11% Anakinra vs 25% standard of care with or without placebo OR] 0·32 [95% CI 0·20–0·51]).

In a subgroup analysis, anakinra was more effective in lowering mortality in patients with CRP >100 mg/L (OR 0·28 [95% CI 0·17–0·47]).

Interestinglh, Anakinra showed a significant survival benefit when given without dexamethasone (OR 0·23 [95% CI 0·12–0·43]), but not with dexamethasone co-administration.

Lastly, unlike some other biologics, the use of Anakinra was not associated with a significantly increased risk of secondary infections (OR 1·35 [95% CI 0·59–3·10]).

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