Anakinra


Anakinra is a biopharmaceutical drug used to treat rheumatoid arthritis. It is a recombinant and slightly modified version of the human interleukin 1 receptor antagonist protein. It is marketed by Swedish Orphan Biovitrum.

Medical use

Anakinra is administered at home by subcutaneous injection.
It is used as a second line treatment to manage symptoms of rheumatoid arthritis after treatment with a disease-modifying antirheumatic drug has failed. It can be used in combination with some DMARDs.
It is used to treat anyone from infants to adults with a cryopyrin-associated periodic syndrome, including neonatal-onset multisystem inflammatory disease.
It also appears to be effective in treating macrophage activation syndrome, a form of cytokine storm.
It is used off label to treat Schnitzler's syndrome.
It has been shown to help treat secondary hemophagocytic lymphohistiocytosis especially in pediatric patients with other rheumatological disorders.
It was not tested in pregnant women, but appeared to be safe in animal studies.
It should not be used in people who have active infections or latent tuberculosis, who have low white blood cells counts, or who are taking TNF inhibitors.

Adverse effects

More than ten percent of people taking Anakinra have injection site reactions, headaches, and have increased levels of cholesterol in their blood.
Between one and ten percent of people have severe infections, decreased white blood cells, or decreased platelets.
It is unclear if taking Anakinra increases the risk of getting cancer; studies are complicated by the fact that people with rheumatoid arthritis are already at higher risk of getting cancer.

Chemistry

Anakinra is a protein that differs from the sequence of Interleukin 1 receptor antagonist by one methionine added to its N-terminus; it also differs from the human protein in that it is not glycosylated, as it is manufactured in Escherichia coli.

History

It was first approved in the US in 2001 and Europe in March 2002.
In June 2018 NHS England published a Clinical Commissioning Policy: Anakinra to treat periodic fevers and autoinflammatory disorders allowing Anakinra to be commissioned as a first-line treatment for Schnitzler's syndrome and in cases where the first-line treatment is not effective for Familial Mediterranean fever, Hyper-IgD syndrome also known as Mevalonate kinase deficiency, and TNF receptor associated periodic syndrome, and a Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Still's Disease refractory to second-line therapy , allowing Anakinra to be commissioned for Adult-onset Still's disease "as a third line treatment where patients are refractory to steroid-sparing effect DMARDs".
Anakinra effectively treated meningitis caused by a rare genetic mutation in the gene NALP3 in a 67-year-old man enrolled in the Undiagnosed Diseases Network. Researchers at Johns Hopkins University announced in 2019 that anakinra given to pregnant mice with Zika virus had reduced fetal deaths and birth defects. In November 2019 researchers at the University of Manchester reported that Anakinra might have a use in preventing breast cancer from spreading to the bones.