{
  "abstract": "Background: Interleukin-1 and interleukin-6 blockade have been widely used in severe COVID-19, but comparative real-world evidence regarding anakinra and tocilizumab in critically ill patients remains limited. We evaluated the associations of first initiation of anakinra or tocilizumab with 28-day and overall in-hospital mortality. Methods: This single-center retrospective ICU cohort included adults with severe COVID-19. During hospital days 2–10, daily actions were classified as anakinra initiation, tocilizumab initiation, or control/defer. Calibrated overlap-weighted modified-Poisson models estimated associations with 28-day and overall in-hospital mortality; ferritin-adjusted sensitivity analyses were performed. Results: Of 306 patients, 241 patients contributed 1,297 eligible person-days. Calibration met the prespecified balance criterion for the included covariates, although effective support for tocilizumab initiation remained limited. For 28-day in-hospital mortality, adjusted RRs versus control/defer were 0.99 (95% CI, 0.80–1.22) for anakinra and 0.99 (95% CI, 0.71–1.37) for tocilizumab. No clear associations were identified in the head-to-head comparison or for overall in-hospital mortality; ferritin-adjusted estimates were similar. Conclusions: In this retrospective ICU cohort, neither anakinra nor tocilizumab initiation showed a clear association with 28-day or overall in-hospital mortality. Estimates were imprecise, particularly for tocilizumab, and remain susceptible to residual confounding.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye",
    "Department of Radiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye",
    "Division of Nephrology, Department of Internal Medicine, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Fevzi Necati Avsar"
    },
    {
      "affs": [
        1
      ],
      "name": "Nihat Kılıcaslan"
    },
    {
      "affs": [
        2
      ],
      "name": "Tuncay Sahutoglu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7vkt7dcqey51g.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0357671",
  "fulltext_url": null,
  "id": "7vkt7dcqey51g",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0357671",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|COVID-19 Clinical Research Studies"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Immune response/Inflammation"
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      "/Medicine and health sciences/Epidemiology/Medical risk factors"
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      "plos",
      "/Medicine and health sciences/Health care/Health care facilities/Hospitals/Intensive care units"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Immune response/Inflammation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/COVID 19"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancer treatment/Cytokine therapy"
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      "/Medicine and health sciences/Pharmaceutics/Drug therapy/Receptor antagonist therapy"
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      "/Physical sciences/Chemistry/Chemical elements/Oxygen"
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  "openalex": "W7206174750",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0357671&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-02",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/7vkt7dcqey51g.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "10.1371/journal.pone.0357671",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0357671"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
    },
    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    },
    {
      "field": "medicine",
      "origin": "plos:infectious diseases",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study",
  "title_text": "Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/7vkt7dcqey51g",
  "venue": "PLOS One",
  "versions": []
}