Around the tenth day after diagnosis, ∼20% of patients with coronavirus disease 2019 (COVID-19)−associated pneumonia evolve toward severe oxygen dependence (stage 2b) and acute respiratory distress syndrome (stage 3) associated with systemic inflammation often termed a “cytokine storm.” Because interleukin-1 (IL-1) blocks the production of IL-6 and other proinflammatory cytokines, we treated COVID-19 patients early in the disease with the IL-1 receptor antagonist, anakinra. We retrospectively compared 22 patients from three different centers in France with stages 2b and 3 COVID-19−associated pneumonia presenting with acute severe respiratory failure and systemic inflammation who received either standard-of-care treatment alone (10 patients) or combined with intravenous anakinra (12 patients). Treatment started at 300 mg⋅d⁻¹ for 5 d, then tapered with lower dosing over 3 d. Both populations were comparable for age, comorbidities, clinical stage, and elevated biomarkers of systemic inflammation. All of the patients treated with anakinra improved clinically (P < 0.01), with no deaths, significant decreases in oxygen requirements (P < 0.05), and more days without invasive mechanical ventilation (P < 0.06), compared with the control group. The effect of anakinra was rapid, as judged by significant decrease of fever and C-reactive protein at day 3. A mean total dose of 1,950 mg was infused with no adverse side effects or bacterial infection. We conclude that early blockade of the IL-1 receptor is therapeutic in acute hyperinflammatory respiratory failure in COVID-19 patients.

在诊断后的第10天左右，约有20％的冠状病毒病2019（COVID-19）相关性肺炎患者发展为严重的氧依赖（2b期）和与系统性炎症相关的急性呼吸窘迫综合征（3期），通常被称为“细胞因子风暴。” 因为白介素-1（IL-1）会阻止IL-6和其他促炎性细胞因子的产生，所以我们在疾病早期使用IL-1受体拮抗剂anakinra治疗了COVID-19患者。我们回顾性地比较了来自法国三个不同中心的22例2b和3期COVID-19相关肺炎，急性严重呼吸衰竭和全身性炎症的患者，这些患者单独接受了标准治疗（10例）或联合静脉注射anakinra （12例）。从300 mg·d开始治疗^-1持续5 d，然后在3 d内逐渐降低剂量。两种人群在年龄，合并症，临床分期和全身性炎症的生物标志物升高方面均具有可比性。所有使用Anakinra治疗的患者在临床上均得到改善（P <0.01），无死亡，无氧需求量显着降低（P <0.05），无创机械通气的天数更多（P<0.06），与对照组相比。根据第3天发烧和C反应蛋白的明显减少判断，anakinra的作用迅速，平均注射总剂量为1,950 mg，无不良副作用或细菌感染。我们得出的结论是，早期阻断IL-1受体可治疗COVID-19患者的急性高炎症性呼吸衰竭。