Kineret (Anakinra)

Anakinra is used to target inflammatory pathways in several rheumatic and autoinflammatory diseases.

• Rheumatoid arthritis: reduces signs and symptoms, improves physical function.
• Systemic juvenile idiopathic arthritis: controls disease activity and prevents joint damage.
• Neonatal‑onset multisystem inflammatory disease (NOMID): alleviates systemic inflammation and organ involvement.
• Cryopyrin‑associated periodic syndromes (CAPS): diminishes fever episodes and inflammatory attacks.

• Anakinra is a recombinant human interleukin‑1 receptor antagonist that competitively binds to the interleukin‑1 type I receptor (IL‑1RI). By occupying this receptor, it blocks the activity of both IL‑1α and IL‑1β, preventing downstream signaling cascades that lead to the production of inflammatory mediators, thereby reducing systemic and joint inflammation. This inhibition curtails the activation of NF‑κB and MAPK pathways, which are central to the inflammatory response.

Anakinra may cause a range of adverse reactions, most of which are mild to moderate in severity.

Common Side Effects

• Injection site reactions: redness, swelling, or pain at the injection site.
• Headache: mild to moderate intensity.
• Nausea: occasional gastrointestinal upset.
• Upper respiratory tract infection: symptoms such as sore throat or congestion.
• Arthralgia: joint pain not related to disease activity.
• Fever: low‑grade temperature increase.

Serious or Rare Side Effects

• Neutropenia: significant reduction in white blood cells.
• Severe infections: including sepsis or opportunistic infections.
• Hypersensitivity reactions: rash, angioedema, or anaphylaxis.
• Elevated liver enzymes: indicating possible hepatic involvement.
• Malignancy: rare reports of cancer development.

Before initiating Anakinra therapy, several safety considerations should be reviewed.

• Infection screening: assess for active or latent infections, especially tuberculosis.
• Live vaccines: avoid administration during treatment and for several weeks after discontinuation.
• Laboratory monitoring: perform baseline and periodic complete blood counts and liver function tests.
• Pregnancy and lactation: use only if potential benefit justifies potential risk; data are limited.
• Concomitant immunosuppressants: evaluate risk of additive immunosuppression.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Anakinra can interact with other medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Live bacterial or viral vaccines: may cause uncontrolled infection.
• Cytotoxic chemotherapy: increased risk of severe neutropenia.
• High-dose systemic corticosteroids: may potentiate immunosuppression.

Moderate Interactions (Monitor Closely)

• Other biologic immunomodulators (e.g., TNF inhibitors): heightened infection risk.
• Antifungal agents (e.g., azoles): possible additive immunosuppressive effect.
• NSAIDs: may increase risk of injection site bleeding.