|Main uses||Rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, Still's disease, COVID-19|
|Side effects||Pain at site of injection, upper respiratory tract infection, headache, nausea, joint pain, fever|
|Elimination half-life||4-6 hrs|
|Chemical and physical data|
|Molar mass||17257.66 g·mol−1|
|(what is this?)|
Anakinra, sold under the brand name Kineret, is a medication used to treat rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, and Still's disease. It is also used in people with COVID-19 who require oxygen therapy. It is given by injection under the skin.
Common side effects include pain at the site of injection, upper respiratory tract infection, headache, nausea, joint pain, and fever. Other side effects may include anaphylaxis. Safety in pregnancy is unclear. It is a recombinant version of the interleukin 1 receptor antagonist protein which blocks the effects of interleukin 1.
Anakinra was approved for medical use in the United States in 2001 and Europe in 2002. In the United Kingdom a week of medication costs the NHS about £180 as of 2021. This amount in the United States costs about 1,250 USD.
It is used as a second line treatment to manage symptoms of rheumatoid arthritis after treatment with a disease-modifying antirheumatic drug (DMARD) has failed. It can be used in combination with some DMARDs.
It was not tested in pregnant women, but appeared to be safe in animal studies.
In December of 2021, the European Medicines Agency (EMA) approved the use of anakinra to include treatment of COVID-19 in adults with pneumonia who require supplemental oxygen and are at high risk of developing severe respiratory failure (inability of the lungs to work properly). High risk is based on a soluble urokinase plasminogen activator receptor (suPAR) level of greater than 6 ng per ml.
In people hospitalized with COVID-19 at increased risk for respiratory failure it showed improvement after treatment. Anakinara is undergoing multiple trials to treat COVID-19. In 2021 a review and meta-analysis of 9 studies involving 1,119 cases concluded that "Available evidence shows that treatment with anakinra reduces both the need for invasive mechanical ventilation and mortality risk of hospitalized non-intubated patients with COVID-19 without increasing the risk of adverse events."
In RA it is generally used at a dose of 100 mg per day.
For COVID it is used at a dose of 100 mg per day for 10 days.
In children it may be used at a dose of 1 to 2 mg/kg per day.
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.
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.
In June 2018 NHS England published a Clinical Commissioning Policy: Anakinra to treat periodic fevers and autoinflammatory disorders (all ages) 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 (TRAPS), and a Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Still's Disease refractory to second-line therapy (adults), 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".
In December 2020, Anakinra was approved by the US Food and Drug Administration for the treatment of Deficiency of the interleukin-1–receptor antagonist (DIRA), a rare autoinflammatory disease of infancy. In 2021, it was announced that the Ministry of Health of the Russian Federation had approved the use of Anakinra for the treatment of CAPS.
In October 2021 NHS England published Clinical Commissioning Policy: Anakinra for Haemophagocytic Lymphohistiocytosis (HLH) for adults and children in all ages, allowing Anakinra to be used in the treatment of haemophagocytic lymphohistiocytosis.
In October 2021 it was reported that the Iranian company PersisGen had developed "a new formulation of Anakinra", named PerkinRA. The results of a clinical trial of PerkinRA had previously been reported. It is marketed by Swedish Orphan Biovitrum.
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.
In 2021, it was reported that Anakinra appeared to reduce the neuropathic pain experienced by patients undergoing chemotherapy with vincristine, saying that "that repurposing anakinra may be an effective co-treatment strategy to prevent vincristine-induced peripheral neuropathy".
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