Continuous Intravenous Anakinra Infusion to Calm the Cytokine Storm in Macrophage Activation Syndrome

Abstract

Objective To report the benefit of a therapeutic approach consisting of intravenous continuous anakinra (recombinant human interleukin‐1 receptor antagonist) infusions in treating severely ill adult patients with secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome (sHLH/MAS). Methods A retrospective chart review of five patients treated at Regions Hospital from 2016‐2019. Demographic, clinical, laboratory characteristics and outcomes were recorded. Results Continuous IV anakinra infusions up to 2400 mg/day resulted in rapid serologic, then clinical response in 4/5 severely ill patients who were refractory to all other therapies including subcutaneous anakinra. Subsequently, 3/5 have been maintained on anakinra or canakinumab with no recurrence of MAS. Conclusion Continuous infusion of IV anakinra may result in rapid serologic and subsequent clinical improvement in adult patients with MAS. This method for treating cytokine storm should be considered in the current COVID‐19 pandemic in the subgroup of patients with severe disease that have a cytokine storm presentation.