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Peer-reviewedCC BY 4.0PLOS One

Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study

  • Fevzi Necati Avsar1
  • Nihat Kılıcaslan2
  • Tuncay Sahutoglu3
  1. 1Department of Internal Medicine, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye
  2. 2Department of Radiology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye
  3. 3Division of Nephrology, Department of Internal Medicine, Sanliurfa Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Türkiye
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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.

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Cite

BibTeXRIS
BibTeX
@article{avsar2026comparative,
  title = {{Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study}},
  author = {Fevzi Necati Avsar and Nihat Kılıcaslan and Tuncay Sahutoglu},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357671},
  url = {https://doi.org/10.1371/journal.pone.0357671},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study
AU  - Fevzi Necati Avsar
AU  - Nihat Kılıcaslan
AU  - Tuncay Sahutoglu
PY  - 2026
DA  - 2026/09/02
JO  - PLOS One
DO  - 10.1371/journal.pone.0357671
UR  - https://doi.org/10.1371/journal.pone.0357671
AB  - 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.
SN  - 1932-6203
ER  -