Anakinra

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Anakinra
Anakinra.png
Clinical data
Trade names Kineret
AHFS/Drugs.com Monograph
MedlinePlus a602001
License data
Pregnancy
category
  • AU: B1
  • US: B (No risk in non-human studies)
Routes of
administration
Subcutaneous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 95%
Metabolism predominantly renal
Elimination half-life 4-6 hrs
Identifiers
CAS Number
DrugBank
ChemSpider
  • none
UNII
KEGG
ChEMBL
Chemical and physical data
Formula C759H1186N208O232S10
Molar mass 17,257.6 g/mol
 NoYesY (what is this?)  (verify)

Anakinra (brand name Kineret) 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.[1]

Medical use[edit]

Anakinra is administered at home by subcutaneous injection.[2]

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.[1][2] It can be used in combination with some DMARDs.[1][2][3]

It is used to treat anyone from infants to adults with a cryopyrin-associated periodic syndrome, including neonatal-onset multisystem inflammatory disease.[1][2]

It used off label to treat Schnitzler's syndrome.[4]

It was not tested in pregnant women, but appeared to be safe in animal studies.[2]

It should not be used in people who have active infections or latent turberculosis, who have low white blood cells counts, or who are taking TNF inhibitors.[2]

Adverse effects[edit]

More than ten percent of people taking anakinra have injection site reactions, headaches, and have increased levels of cholesterol in their blood.[1] Between one and ten percent of people have severe infections, decreased white blood cells, or decreased platelets.[1] 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.[1][3]

Chemistry[edit]

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.[2]

History[edit]

It was first approved in the US in 2001[2] and Europe in March 2002.[1]

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),[5] 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".[6]

References[edit]

  1. ^ a b c d e f g h "UK Anakinra label". UK Electronic Medicines Compendium. 5 October 2017. Retrieved 23 March 2018. 
  2. ^ a b c d e f g h "US Anakinra label" (PDF). FDA. May 2016. Retrieved 23 March 2018.  For label updates see FDA index page for BLA 103950
  3. ^ a b Singh, JA; Hossain, A; Tanjong Ghogomu, E; Kotb, A; Christensen, R; Mudano, AS; Maxwell, LJ; Shah, NP; Tugwell, P; Wells, GA (13 May 2016). "Biologics or tofacitinib for rheumatoid arthritis in incomplete responders to methotrexate or other traditional disease-modifying anti-rheumatic drugs: a systematic review and network meta-analysis". The Cochrane Database of Systematic Reviews (5): CD012183. doi:10.1002/14651858.CD012183. PMID 27175934. 
  4. ^ Gusdorf, L; Lipsker, D (August 2017). "Schnitzler Syndrome: a Review". Current rheumatology reports. 19 (8): 46. doi:10.1007/s11926-017-0673-5. PMID 28718061. 
  5. ^ NHS England (29 June 2018). Clinical Commissioning Policy: Anakinra to treat periodic fevers and autoinflammatory disorders (all ages) (PDF). Retrieved 9 July 2018. 
  6. ^ NHS England (29 June 2018). Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Still's Disease refractory to second-line therapy (adults) (PDF). Retrieved 13 July 2018.