Abstract: Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients. Learning points: Up to one third of patients with severe COVID-19 pneumonia progress to acute respiratory distress syndrome (ARDS).Pulmonary fibrosis is a known consequence of ARDS.Our study shows promising results regarding the efficacy and safety of anakinra used in late-phase COVID-19 infection in patients with pulmonary fibrosis secondary to ARDS.

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