The National Institute for Health and Care Excellence (NICE) has produced a rapid evidence summary on use of Anakinra for COVID-19 associated secondary haemophagocytic lymphohistiocytosis.
Key medicines-related issues
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome, which can lead to a cytokine storm, tissue damage and multi-organ failure. It has a high mortality rate. Viral infections are the most common cause of secondary HLH (sHLH).
A hyperinflammatory response develops in some people with COVID-19, which may be localised to the lungs or lead to widespread systemic illness and sHLH.
Anakinra is recommended (off label) in treatment algorithms for sHLH as part of a multi-disciplinary team decision-making process. In critical illness, subcutaneous absorption can be unreliable and intravenous dosing is sometimes used in clinical practice to achieve a higher and faster maximal plasma concentration (it is not licensed for intravenous administration).
At the time of the review, no relevant papers were identified in the searches undertaken for this evidence review. Therefore, no evidence is available to determine whether anakinra is effective, safe or cost effective for treating adults and children with sHLH triggered by SARS-CoV-2 or a similar coronavirus.
At this time, policy decisions on whether anakinra should be used for treating COVID-19 associated sHLH will need to consider data extrapolated from studies assessing anakinra for related conditions, such as macrophage activation syndrome, non-coronavirus sHLH and hyperinflammation in people with COVID-19 and acute respiratory distress syndrome (ARDS).