AnakinraRx

Trade Names: Kineret

Drug Class: Biologic DMARD, IL-1 receptor antagonist

Preparations: 100-mg pre-filled syringe

Dose: For RA 100 mg subQ injection daily. Decrease dose if renal function impaired.

Indications: RA, NOMID

Mechanism of Action: Binds to IL-1 receptors and blocks the effects of the cytokine

Contraindications: Hypersensitivity to anakinra or E. coli derived proteins, active infection, do not use with TNF-antagonists, other biologics, and tofacitinib. Avoid live virus vaccines.

Precautions: Discontinue if patient develops an infection

Monitoring: Monitor clinically for infection; CBC monthly for 3 months, then every 3 months, TB testing at baseline and consider retesting periodically based on risk.

Pregnancy Risk: B

Adverse Effects
Common: Injection site reactions (73% mild, 24% moderate, 2% severe)
Less common: Allergy, infection (bacterial, but also atypical infections), leukopenia
Rare: Neutropenia, thrombocytopenia

Drug Interactions: Concurrent use of other immunosuppressants, particularly TNF antagonists, may increase risk of infection

Patient Instructions: Avoid live virus vaccines. Avoid pregnancy. Stop injections if an infection or a fever develops that lasts more than a few days.

Comments: Combination therapy with methorexate is generally well tolerated and is more effective than monotherapy. Anakinra appears less effective than TNF antagonists and other modern drugs for RA and is little used for RA in clinical practice. Combination with TNF antagonists is avoided because of increased risk of infection. In case-series, anakinra treatment for  3 days (off-label) is effective for the treatment of acute gout in patients unable to tolerate, or not responding to, standard therapies such as NSAIDs, colchicine or corticosteroids. In small case-series, anakinra has also been reported to be effective in other conditions including adult-onset Still’s disease and idiopathic recurrent pericarditis.

Clinical Pharmacology: Half-life is 6 hours with renal excretion. Biologic agents are not metabolized and have few drug interactions.

Cost: $$$$$

BIBLIOGRAPHY

Cohen S, Hurd E, Cush J, et al. Treatment of rheumatoid arthritis with anakinra, a recombinant human interleukin-1 receptorantagonist, in combination with methotrexate: results of a twenty-four-week, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum2002;46:614–624. PMID:11920396

Nam JL, Ramiro S, Gaujoux-Viala C, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum
Dis 2014 ;73(3):516-28. PMID:24399231

Giampietro C, Ridene M, Lequerre T et al. Anakinra in adult-onset Still's disease: long-term treatment in patients resistant to conventionaltherapy. Arthritis Care Res 2013;65:822-6. PMID:23225779

Khanna PP, Gladue HS, Singh MK, et al. Treatment of acute gout:A systematic review. Semin Arthritis Rheum. 2014 ;44:31-38. PMID: 24650777