Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial
- Type de publi. : Article dans une revue
- Date de publi. : 01/03/2021
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Auteurs :
Pierre-Louis TharauxGilles PialouxArthur PavotXavier MarietteOlivier HermineMatthieu Resche-RigonRaphaël PorcherPhilippe H. RavaudSerge BureauMaxime DougadosAnnick TibiÉlie AzoulayJacques CadranelJoseph EmmerichMuriel FartoukhBertrand GuidetGiovanna MarazziKarine LacombeMatthieu MahevasFrédéric PeneValérie Pourchet-MartinezFrédéric SchlemmerYazdan YazdanpanahGabriel BaronElodie PerrodeauDamien VanhoyeCécile KedziaLauren DemervilleAnne Gysembergh-HoualAlexandre BourgoinSarah DalibeyNabil RakedLakhdar MameriStéphanie AlarySamir HamiriaThinhinane BarizHala SemriDhiaa Meriem HaiMoustafa BenaflaMohamed BelloulPernelle VauboinSaskia FlamandClaire PachecoAnouk Walter-PetrichEmilia StanSouad BenarabCorine NyanouClaire MontlahucLucie BiardRobin CharreteurCeline DupréKévin CardetBlandine LehmannKamyl BaghliClaire MadelaineEric d'OrtenzioOriane PuéchalCaroline SemailleLaurent SavaleAnatole HarroisSamy FigueiredoJacques DuranteauNadia AnguelXavier MonnetChristian RichardJean-Louis TeboulP. DurandPierre TissieresMitja JevnikarDavid MontaniSophie BulifonXavier JaïsOlivier SitbonStéphan PavyNicolas NoelOlivier LambotteLelia EscautStéphane JauréguiberryElodie BaudryChristiane VernyMathilde NoaillonEdouard LefèvreMohamad ZaidanClotilde Le Tiec Le TiecCéline Verstuyft VerstuyftAnne-Marie RoquesLamiae GrimaldiDomitille MolinariGaël LeprunAlain FourreauLaurent CyllyMyriam VirlouvetRamdane MeftaliSolène FabreMarion LicoisAsmaa MamouneYacine BoudaliSophie Georgin-LaviallePatricia SenetA. SoriaAntoine ParrotHélène FrançoisNathalie RozensztajnEmmanuelle BlinPascaline ChoinierJuliette CamusetJean-Simon RechAntony CanellasCamille Rolland-DebordNadège LemariéNicolas BelaubeMarine NadalMartin SiguierCamille Petit-HoangJulie ChasElodie DrouetMatthieu LemoineAudrey PhibelLucie AunayEliane BertrandSylviane RavatoMarie VayssettesAnne AddaCeline WilpottePélagie ThibautJulie FillonIsabelle DebrixSoraya FellahiJean-Philippe BastardGuillaume LefèvreVincent FalletJacques-Eric GottenbergYves HansmannEmmanuel AndrèsSophie BayerGuillaume BeckerFrédéric BlancStéphane BrinVincent CastelainEmmanuel ChatelusEva ChatronOlivier CollangeFrançois DanionFrédéric de BlayEric DemonsantPierre DiemunschSophie DiemunschRenaud FeltenBernard GoichotValentin GreigertAurélien GuffroyBob HegerAnne HuttCharlotte KaeufferLoic KassegneAnne Sophie KorganowPierrick Le BorgneNicolas LefebvreTristan MartinPaul Michel MertesCatherine MetzgerNicolas MeyerGabriel NisandEric NollMathieu OberlinSophie Ohlmann-CaillardVincent PoindronJulien PottecherYvon RuchCédric SublonHakim TayebiFrançois WeillArsène MékinianDorothée ChopinOlivier FainMarc GarnierJessica Krause Le GarrecMarjolaine MorgandJerome PacanowskiTomas UrbinaChloe McavoyMaria PereiraGladys AratusLaurence BerardTabassome SimonAnne Daguenel-NguyenMarie AntignacCéline LeplayJean-Benoit ArletJean-Luc DiehlFlorence BellenfantAnne BlanchardAlexandre BuffetBernard CholleyAntoine FayolEdouard FlamarionAnne GodierThomas GorgetSophie-Rym HamadaCaroline Hauw-BerlemontJean-Sébastien HulotDavid LebeauxMarine LivrozetAdrien MichonArthur NeuschwanderMarie-Aude PenetBenjamin PlanquetteBrigitte RanqueOlivier SanchezGeoffroy VolleSandrine BrioisMathias CornicVirginie EliseeDenis, JesuthasanJuliette Djadi-PratPauline JouanyRamon JunqueraMickael HenriquesAmina KebirIsabelle LehirJeanne MeunierFlorence PatinValérie PaquetAnne TréhanVéronique VignaBrigitte SabatierDamien BergerotCharléne JouveCamille KnospOlivia LenoirNassim MahtalLéa ResminiF-Xavier LescureJade GhosnAntoine BachelardTimothee BironneRaphaël BorieAgathe BounhiolCatherine BoussardJeanne ChauffierSolaya ChalalLynda ChalalMalikhone ChansombatPaul CrespinBruno CrestaniOlivia DaconceicaoLaurene DeconinckPhilippe DieudeAntoine DossierMarie DubertGreggory DucrocqAxelle FuentesAnne GervaisMarie GilbertValentina IserniaSophie IsmaelVeronique JolyZelie JuliaSylvie LarivenSylvie Le GacDiane Le PluartFrancoise LouniAwa NdiayeThomas PapoMarion PariseyBao PhungAnnabelle PourbaixAnne RachlineChristophe RiouxAurelie SautereauPhilippe Gabriel StegHassan TarhiniSimon ValayerDorothee ValloisPaul VermesThomas VolpeYann NguyenVasco HonselEmmanuel WeissAnaïs CodorniuVirginie ZarroukVictoire de LastoursMatthieu UzzanOlivier OlivierGeoffrey RossiNaura GamanyRoza RahliZeina LouisDavid BoutboulLionel GalicierYaël AmaraGabrielle ArcherAmira BenattiaAnne BergeronLouise BondeelleNathalie de CastroMelissa ClémentMichaël DarmontBlandine DenisClairelyne DupinElsa FeredjDelphine FeyeuxAdrien JosephEtienne LenglinéPierre Le GuenGeoffroy LiégeonGwenaël LorillonAsmaa MabroukiEric MariotteGrégoire Martin de FrémontAdrien MirouseJean-Michel MolinaRégis Peffault de LatourÉric OksenhendlerJulien SaussereauAbdellatif TaziJean-Jacques TudesqLara ZafraniIsabelle BrindeleEmmanuelle BugnetKarine Celli LebrasJulien ChabertLalia DjaghoutCatherine FauvauxAnne Lise JeguEwa KozaliewiczMartine MeunierMarie-Thérèse TremorinClaire DavoineIsabelle MadeleineSophie Caillat-ZucmanConstance DelaugerreFlorence MorinDamien SèneRuxandra BurlacuBenjamin ChoustermanBruno MégarbaneP. RichetteJean-Pierre RivelineAline FrazierÉric VicautLaure BertonTassadit HadjamMiguel Alejandro Vasquez-IbarraClément JourdaineAude JacobJulie SmatiStéphane RenaudPhilippe ManivetClaire PerninLydia SuarezLuca SemeranoSébastien AbadRuben BenainousCoralie Bloch QueyratNicolas BonnetSabrina BrahmiJohann CailholYves CohenCeline ComparonHugues CordelRobin DhoteNathalie DournonBoris DuchemannNathan EbsteinBenedicte Giroux-LeprieurJeanne Goupil de BouilleAnne JacolotHilario NunesJohanna OzielVanessa RathouinMarthe RigalDominique RoulotClaire TantetYurdagül UzunhanNathalie Costedoat-ChalumeauZakaria Ait HamouSarah BenghanemPhilippe BlancheEtienne CanouiNicolas CarlierBenjamin ChaigneAdrien ContejeanBertrand DunoguePierre DuplandAurélie Durel - MaurisseRémy GauzitPaul JaubertHassan JoumaaMathieu JozwiakSolen KernéisMarie LachatreHélène LafoestePaul LegendreLiem Binh Luong NguyenJonathan MareyCaroline MorbieuLuc MouthonLee NguyenLola-Jade PalmieriAlexis RégentTali-Anne SzwebelBenjamin TerrierCorinne GuerinJérémie ZerbitKahina CherefKamil ChitourMamadou Salif CisseAda ClarkeGaelle ClavereIsabelle DusanterCaroline GaudefroyMoez JallouliSami KoltaCatherine Le BourloutNathalie MarinNathalie MenageAlexandre MooresIsabelle PeigneyCédric PierronSamira Saleh-MghirMathilde ValletMarc MichelGiovanna MelicaJean-Daniel LelievreElena FoisPascal LimMarie MatignonConstance GuillaudAlaki ThiemeleDavid SchmitzMarion BouhrisSyllia BelazouzLaetitia LanguilleArmand Mekontso-DessapsThiziri SadaouiJulien MayauxPatrice CacoubJean-Christophe CorvolCéline LouapreSara SambinLouise-Laure MarianiKirsten Müller-VahlFlorence TubachCandice EstellatLinda GimenoKarine MartinAïcha BahVixra KeoSabrine OuamriYasmine MessaoudiNessima YellesPierre FayeSébastien CavelotCecile LarchevequeLaurence AnnonayJaouad BenhidaAida Zahrate-GhoulSoumeya HammalRidha BelilitaMarie LecronierAlexandra BeurtonLuc HaudebourgRobin DelerisJulien Le MarecSara VirolleSafaa NemlaghiCôme BureauPierre MoraMartin de SarcusOlivier ClovetBaptiste DuceauPaul Henri GrisotMarie Hélène PariJérémy ArzoineUlrich ClaracMorgane FaureJulie DelemazureMaxence DecaveleElise MorawiecAlexandre DemouleMartin DresMathieu VautierYves AllenbachOlivier BenvenisteGaelle LerouxAude RigoletPerrine Guillaume-JugnotFanny DomontAnne Claire DesboisCloé ComarmondNicolas ChamptiauxSegolene ToquetAmine GhembazaMatheus VieiraGeorgina MaaloufGonçalo BoletoYasmina FerfarFanny CharbonnierClaire AguilarFanny Alby-LaurentMarie-Alexandra AlyanakianPrissile BakouboulaChristine BroissandCarole BurgerClara Campos-VegaNathalie ChavarotLaure ChoupeauxBenjamin FournierSophie GranvilleElodie IssoratClaire RouzaudDamien VimpereGuillaume GeriNawal DerridjNaima SguiouarHakim MeddahMourad DjadelHelene Chambrin-LauvrayJean-Charles Duclos-ValléeFaouzi SalibaSophie-Caroline SacleuxIlias KoumisJean-Marie MichotAnnabelle StoclinEmeline ColombaFanny PommeretChistophe WillekensMadona SakkalRosa da SilvaValérie DejeanYasmina MekidInes Ben-MabroukCaroline PradonLaurence DrouardValérie Camara-ClayetteAlexandre MorelGilles GarciaAbolfazl MohebbiFérial BerbourMélanie DehaisAnne-Lise PouliquenAlison KlasenLoren Soyez-HerkertJonathan LondonYounes KeroumiEmmanuelle GuillotGuillaume GraillesYounes El AmineFanny DefrancqHanane FodilChaouki BourasDominique DautelNicolas GambierThierno DieyeAnaïs RazurelBoris BienvenuVictor LanconLaurence LecomteKristina BeziriganyanBelkacem AsselateLaure AllanicElena KiourisMarie-Hélène LegrosChristine LemagnerPascal MartelVincent ProvitoloFélix AckermannMathilde Le MarchandAurélie Clan Hew WaiDimitri FremontElisabeth CoupezMireille AddaFrédéric DuéeLise BernardAntoine GrosEstelle HenryClaire CourtinAnne PattynPierre-Grégoire GuinotMarc BardouAgnes MaurerJulie JambonAmélie Cransac-MietCorinne PernotBruno MourvillierAmélie ServettazGaetan DesléeAlain WynckelPhilippe BenoitEric MarquisDamien RouxCoralie GernezCécile YelnikJulien PoissyMandy NizardFanette DeniesHélène GrosJean-Jacques MouradEmmanuelle SaccoSophie Renet
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Organismes :
Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
Assistance publique - Hôpitaux de Paris (AP-HP)
Université Paris Cité
Optimisation thérapeutique en Neuropsychopharmacologie
Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
Centre de recherche en Myologie – U974 SU-INSERM
Centre de recherche en Myologie – U974 SU-INSERM
- Publié dans The Lancet Respiratory Medicine le 23/10/2020
Résumé : Background: Patients with COVID-19 pneumonia have an excess of inflammation and increased concentrations of cytokines including interleukin-1 (IL-1). We aimed to determine whether anakinra, a recombinant human IL-1 receptor antagonist, could improve outcomes in patients in hospital with mild-to-moderate COVID-19 pneumonia. Methods: In this multicentre, open-label, Bayesian randomised clinical trial (CORIMUNO-ANA-1), nested within the CORIMUNO-19 cohort, we recruited patients from 16 University hospitals in France with mild-to-moderate COVID-19 pneumonia, severe acute respiratory syndrome coronavirus 2 infection confirmed by real-time RT-PCR, requiring at least 3 L/min of oxygen by mask or nasal cannula but without ventilation assistance, a score of 5 on the WHO Clinical Progression Scale (WHO-CPS), and a C-reactive protein serum concentration of more than 25 mg/L not requiring admission to the intensive care unit at admission to hospital. Eligible patients were randomly assigned (1:1) using a web-based secure centralised system, stratified by centre and blocked with varying block sizes (randomly of size two or four), to either usual care plus anakinra (200 mg twice a day on days 1-3, 100 mg twice on day 4, 100 mg once on day 5) or usual care alone. Usual care was provided at the discretion of the site clinicians. The two coprimary outcomes were the proportion of patients who had died or needed non-invasive or mechanical ventilation by day 4 (ie, a score of >5 on the WHO-CPS) and survival without need for mechanical or non-invasive ventilation (including high-flow oxygen) at day 14. All analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT04341584, and is now closed to accrual. Findings: Between April 8 and April 26, 2020, we screened 153 patients. The study was stopped early following the recommendation of the data and safety monitoring board, after the recruitment of 116 patients: 59 were assigned to the anakinra group, and 57 were assigned to the usual care group. Two patients in the usual care group withdrew consent and were not analysed. In the analysable population, the median age was 66 years (IQR 59 to 76) and 80 (70%) participants were men. In the anakinra group, 21 (36%) of 59 patients had a WHO-CPS score of more than 5 at day 4 versus 21 (38%) of 55 in the usual care group (median posterior absolute risk difference [ARD] -2·5%, 90% credible interval [CrI] -17·1 to 12·0), with a posterior probability of ARD of less than 0 (ie, anakinra better than usual care) of 61·2%. At day 14, 28 (47%; 95% CI 33 to 59) patients in the anakinra group and 28 (51%; 95% CI 36 to 62) in the usual care group needed ventilation or died, with a posterior probability of any efficacy of anakinra (hazard ratio [HR] being less than 1) of 54·5% (median posterior HR 0·97; 90% CrI 0·62 to 1·52). At day 90, 16 (27%) patients in the anakinra group and 15 (27%) in the usual care group had died. Serious adverse events occurred in 27 (46%) patients in the anakinra group and 21 (38%) in the usual care group (p=0·45). Interpretation: Anakinra did not improve outcomes in patients with mild-to-moderate COVID-19 pneumonia. Further studies are needed to assess the efficacy of anakinra in other selected groups of patients with more severe COVID-19. Funding: The Ministry of Health, Programme Hospitalier de Recherche Clinique, Foundation for Medical Research, and AP-HP Foundation.
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