Uses of Anakinra (Kineret)
Anakinra is primarily used to treat inflammatory conditions by blocking interleukin-1 (IL-1) activity, with established efficacy in rheumatoid arthritis, NOMID/CAPS, DIRA, and as a treatment option for COVID-19-related hyperinflammation. 1
FDA-Approved Indications
- Rheumatoid Arthritis (RA): For moderate to severe active RA in adults who have failed one or more disease-modifying antirheumatic drugs (DMARDs) 2
- Cryopyrin-Associated Periodic Syndromes (CAPS): Specifically for Neonatal-Onset Multisystem Inflammatory Disease (NOMID) 2
- Deficiency of Interleukin-1 Receptor Antagonist (DIRA): For treatment of this rare autoinflammatory condition 2
Off-Label Uses with Strong Evidence
COVID-19 Related Conditions
- COVID-19 with Hyperinflammation: In pediatric patients with severe COVID-19 and hyperinflammation who have refractory disease despite glucocorticoid administration 1
- Multisystem Inflammatory Syndrome in Children (MIS-C): For refractory disease despite IVIG and steroid treatment 1
Autoinflammatory Conditions
- Adult-onset Still's Disease: Effective in controlling symptoms 3
- Systemic-onset Juvenile Idiopathic Arthritis: Particularly effective for the inflammatory component 3
Administration and Dosing
- Standard dose: 100 mg daily subcutaneous injection for adults with RA 4
- Higher doses (>4 mg/kg/day IV or SC) may be used for COVID-19 hyperinflammation 1
- For MIS-C, high-dose anakinra (>4 mg/kg/day) is recommended for refractory disease 1
- Dosage adjustment required for patients with kidney problems 2
Safety Profile
Common Side Effects
- Injection site reactions: Occur in approximately 25% of patients (pain, erythema, swelling, pruritus) 2
- Infections: Increased risk, especially at higher doses (>100 mg) 4
- Neutropenia: Monitor complete blood count
Serious Adverse Events
- Serious infections: Monitor for signs of infection during treatment 2
- Allergic reactions: Including anaphylaxis, particularly in DIRA patients during the first several weeks of treatment 2
- Immunogenicity: Development of anti-anakinra antibodies 4
Clinical Considerations
- Anakinra appears to be safe in severe infections, making it suitable for COVID-19 treatment 1
- Pre-intubation administration in COVID-19 patients with ARDS may be more beneficial 1
- Should not be used concurrently with TNF blockers due to increased infection risk 2
- Patients should not receive live vaccines while on anakinra 2
- For COVID-19 treatment, anakinra is preferred over tocilizumab based on safety profile 1
Monitoring Recommendations
- Regular monitoring for signs of infection
- Liver function tests should be monitored, especially in COVID-19 patients 1
- Assessment of injection site reactions
- Evaluation of treatment response through clinical symptoms and inflammatory markers
Anakinra's relatively short half-life (4-6 hours) allows for rapid discontinuation if adverse events occur, which is an advantage over other biologics with longer half-lives when treating acute inflammatory conditions.
AI: I've provided a comprehensive overview of anakinra's uses based on the FDA label and clinical guidelines. The information prioritizes mortality and morbidity outcomes, particularly highlighting its role in life-threatening conditions like COVID-19 hyperinflammation and MIS-C.