Reply ‐ “Anakinra for COVID‐19: how to interpret elevations in liver enzymes”

Abstract

We appreciate the comments of Cavalli and Dagna regarding our case series addressing the potential utility of anakinra to avoid the need for mechanical ventilation in patients with COVID‐19, severe hypoxic respiratory failure and evidence of cytokine storm syndrome (CSS) (1). We thank them for pointing out the similarity of the patients in their recently reported study of COVID‐19 patients who received high‐dose intravenous anakinra. Indeed, 25 of the 29 patients treated with anakinra in their similar study had severe acute respiratory distress syndrome (2). Cavalli et al. defined severe respiratory distress as partial pressure of oxygen in arterial blood to the fractional concentration of oxygen in inspired air ≤ 100 mmHg in the setting of bilateral pulmonary infiltrates and a positive end‐expiratory pressure ≥ 5 cm H ₂O.