Anakinra

Anakinra Brand Name– Kineret

What is Anakinra

Anakinra is a recombinant, non-glycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra).

The drug is produced by recombinant DNA technology using an E. coli bacterial expression system.

Anakinra is useful for treating rheumatoid arthritis (RA) and some other inflammatory conditions.

In adults with moderately to severely active RA, anakinra improves signs and symptoms of the disease and slows the progression of structural damage.

Anakinra was considered but not included in the American College of

Rheumatology 2015 guidelines due to its infrequent use at that time in RA compared to other available treatments and lack of new data since 2012; however, tumor necrosis factor (TNF) inhibitors are usually first-line choices in the biologic treatment categories due to the long-term safety data and the amount of experience associated with the TNF biologics.

For adult RA, anakinra may be used as monotherapy; the drug may also be used with other disease-modifying antirheumatic drugs (DMARDs). The ideal combination of therapy for individual RA patients is determined by treat to target strategies and severity of disease.

While anakinra has been studied in pediatric patients 2 years and older with polyarticular juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA), the study data were insufficient to establish efficacy for this condition, and use for JRA/JIA is not recommended.

Anakinra is helpful for the treatment of Cryopyrin-Associated Periodic Syndromes (CAPS) such as Muckle-Wells Syndrome (MWS), Familial Cold Auto-Inflammatory Syndrome (FCAS), and Neonatal-Onset Multisystem Inflammatory Disease (NOMID), which is also called Chronic Infantile Neurological, Cutaneous and Articular Syndrome (CINCA).

Of all the forms of CAPS, NOMID/CINCA has the highest severity of chronic inflammation.

Among patients with NOMID, disease symptoms and serum markers of inflammation usually worsened within 5 days of anakinra withdrawal and promptly responded to anakinra re-initiation.

Indications

  1. coronavirus disease 2019 (COVID-19)
  2. cryopyrin-associated periodic syndromes (CAPS)
  3. Kawasaki disease
  4. rheumatoid arthritis
  5. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

INVESTIGATIONAL USE: For adjunctive use in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the virus that causes coronavirus disease 2019 (COVID-19)

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. angioedema
  4. antibody formation
  5. arthralgia
  6. diarrhea
  7. ecchymosis
  8. elevated hepatic enzymes
  9. eosinophilia
  10. fever
  11. headache
  12. hepatitis
  13. hypercholesterolemia
  14. infection
  15. injection site reaction
  16. nausea
  17. neutropenia
  18. new primary malignancy
  19. pharyngitis
  20. pruritus
  21. rash
  22. sinusitis
  23. thrombocytopenia
  24. urticaria
  25. vomiting

Monitoring Parameters

  • CBC with differential
  • tuberculin skin test

Contraindications

  • asthma
  • bone marrow suppression
  • breast-feeding
  • E. coli protein hypersensitivity
  • fungal infection
  • geriatric
  • immunosuppression
  • infants
  • infection
  • mycobacterial infection
  • neonates
  • neoplastic disease
  • neutropenia
  • new primary malignancy
  • pregnancy
  • renal failure
  • renal impairment
  • tuberculosis
  • vaccination

Interactions

  • Abatacept
  • Adalimumab
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Baricitinib
  • Canakinumab
  • Certolizumab pegol
  • Etanercept
  • Golimumab
  • Infliximab
  • Influenza Virus Vaccine
  • Intranasal Influenza Vaccine
  • Live Vaccines
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Measles/Mumps/Rubella Vaccines, MMR
  • Rilonacept
  • Rituximab
  • Rituximab; Hyaluronidase
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Sarilumab
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • Tocilizumab
  • Tofacitinib
  • Tumor Necrosis Factor modifiers
  • Typhoid Vaccine
  • Upadacitinib
  • Varicella-Zoster Virus Vaccine, Live
  • Yellow Fever Vaccine, Live
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