Anakinra

Question 1

What class does Anakinra belong to?

Answer 1

DMARDs

Cytokine modulators

Question 2

What is Anakinra?

Answer 2

Anakinra is a recombinant, non glycosylated human IL-1 receptor antagonist.
It has an extra methionie residue at the amino terminus, differentiating it from the nomral human IL-1 receptor antagonist.

Question 3

What is Anakinra indicated for?

Answer 3

Rhematoid arthritis in combination with MTX

Neonatal onset multisystem inflammatory disease

Question 4

What are examples of other drugs in the same class as Anakinra?

Answer 4

Adalimumab
Etanercept
Infliximab
Tocilizumab

Question 5

What is the dose of Anakinra given to Rheumatoid Arthritis patients?

Answer 5

Adult (<18 years): 100mg OD via Subcut injection

Question 6

What is the mechanism of action of Anakinra?

Answer 6

Anakinra competitively binds to the interleukin 1 receptor to inhibit the action of elevated levels of IL-1.

IL-1 normally results in cartilage degradation and bone resorption.

Question 7

What is the role of Anakinra in Rheumatoid Arthritis therapy?

Answer 7

To treat RA in patients unresponsive to MTX alone.

NOT for the routine management of Rheumatoid arthritis

Question 8

What are the characteristic pharmacokinetic and pharmacodynamic parameters of Anakinra?

Answer 8

Absolute bioavailbitliy: 95% (following subcut injection of 70mg)

Half life: 4-6 hours

Clearance: variable and increases with increased CrCl and body weight

Question 9

What are some precautions associated with Anakinra use?

Answer 9

predisposition to infection
history of asthma
blood disorders (Neutropenia)

Pregnancy class b1: manufactuer advised to avoid
avoid in breastfeeding - insufficient data

eGFR 30-50ml/min/1.73m^2 avoid if less than 30mL/min/1.73m^2

Question 10

What are the contraindications of anakinra use?

Answer 10

neutropenia
serious/untreated infection
severe renal impairment
live vaccines

Question 11

What are the interactions of Anakinra?

Answer 11

avoid concomitant use with adalimumab, cetrolizumab pegol, etanercept, golimumab, infliximab and live vaccines

Question 12

What are the adverse effects associated with Anakinra?

Answer 12

injection site reactions,
headache, 
infections
neutropenia
antibody formation
allergy (rare)
malignancy

Question 13

What are the alarm bells associated with anakinra use?

Answer 13

Be aware of neutropenia.

Monitor neutrophil count before treatment, then monthly for 6 months.
Then monitor every 3 months and discontinue if neutropenia develops.

Patients to seek medical advice if they develop fever, sore throat, infection etc (symptoms suggestive of neutropenia)