Discussion
SARS-CoV-2 infection, abnormal chest, interstitial pneumonia
COVID-19 PNEUMONIA, SARS-COV-2 INFECTION, INTERSTITIAL PNEUMONIA
This randomized clinical trial was designed early in the COVID-19 pandemic to assess whether anakinra could reduce the need for mechanical ventilation and improve other key relevant outcomes in patients with severe COVID-19 pneumonia and hyperinflammation. This study failed to meet the primary efficacy end point of preventing mechanical ventilation, although improved oxygenation in terms of POur findings seem to agree with those of a Cochrane systematic review,Nevertheless, our results differ substantially from those of the double-blind, randomized, placebo-controlled, phase 3 SAVE-MORE trial,The mean time from the date of diagnosis of SARS-CoV-2 infection to the date of randomization was 6 days. This means that many patients received a diagnosis of SARS-CoV-2 infection on an outpatient basis before being admitted to hospital and being randomized. The mean time from the date of diagnosis of interstitial pneumonia to date of randomization was 2 days. This delay could cause the patient to worsen abruptly and anakinra to be started late, when the hyperinflammation is already established.Interestingly, our study found that a significantly lower proportion of patients in the anakinra group had abnormal chest imaging findings compared with patients in the SoC group at day 15, which might suggest a potential antifibrotic effect of the drug.