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anakinra (Kineret)

Indications: 1) treatment of rheumatoid arthritis (FDA approved 2001)* 2) adult-onset Still's disease (off-label) [4] 3) cryopyrin-associated periodic syndrome [4] 4) acute gouty arthritis (off-label) [4,5,6] * rarely used for rheumatoid arthritis since other biologic DMARDs superior [4] Contraindications: - concurrent use of other biologic agent (TNF inhibitor, rituximab, abatacept) Pregnancy category: B Dosage: - 1-2 mg/kg SC in combination with methotrexate [3] Monitor: - complete blood count (CBC) at baseline & every 3 months [4] Adverse effects: - reversible neutropenia [4] Laboratory: - anakinra in serum/plasma Mechanism of action: - recombinant interleukin-1 beta inhibitor [4] - pharmaceutical form of IL-1 receptor antagonist protein Notes: Manufacturer: Amgen Management: - whenever possible bring patients up to date on vaccinations prior to initiating biologic immunosuppressive agent [4]

Interactions

drug adverse effects of immunosuppressive agents monitor with immunosuppressive agents

Related

interleukin-1; lymphocyte-activating factor (IL1)

General

biologic immunosuppressive agent (biologic agent, biologic immune modulator) interleukin-1 receptor antagonist protein; IL-1ra; IL-1RN; IRAP; IL1 inhibitor; ICIL-1RA (IL1RN, IL1F3, IL1RA)

References

  1. Prescriber's Letter 9(2):S1 2002
  2. Prescriber's Letter 9(3):13 2002
  3. Journal Watch 22(9):70, 2002 Dayer J-M & Bresniban R, Targeting interleukin-1 in the treatment of rheumatoid arthritis. Arthritis Rheum 46:574, 2002 PMID: 11920390
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
  5. Thueringer JT, Doll NK, Gertner E. Anakinra for the treatment of acute severe gout in critically ill patients. Semin Arthritis Rheum. 2015 Aug;45(1):81-5. Epub 2015 Feb 20. PMID: 25795473
  6. Liew JW, Gardner GC. Use of anakinra in hospitalized patients with crystal-associated arthritis. J Rheumatol 2019 Oct; 46:1345 PMID: 30647192 http://www.jrheum.org/content/46/10/1345