Anakinra is a recombinant IL-1 inhibitor that is currently FDA approved for rheumatoid arthritis, cryopyrin-associated Periodic Syndromes, and Deficiency of IL-1 Receptor Antagonist.
IL-1β is a pro-inflammatory cytokine, and in conjunction with other pro-inflammatory cytokines and interferon, can trigger hyperinflammation and ARDS which is often seen in severe COVID19. Throughout the pandemic, Anakinra has been evaluated in numerous retrospective and randomized controlled trials for COVID-19. It was recently granted emergency use authorization by the US FDA for use in hospitalized adults with COVID-19 who require supplemental oxygen
and who are at risk for progression to severe disease and are likely to have an elevated plasma suPAR (soluble urokinase plasminogen activator receptor)

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The guideline panel suggests against anakinra for the routine treatment of hospitalized patients with severe COVID-19. Research is needed to identify which patients are most likely to benefit from this drug in settings where suPAR testing is not available (e.g. the US).


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