Anakinra (Kineret)

medicine injections

Anakinra is a biologic drug that may be used to treat rheumatoid arthritis if either the standard medications do not work well or if they cannot be used. A biologic drug is man-made through genetic-engineering techniques and closely related to a protein that occurs naturally in the body. It helps decrease inflammation in arthritis.

Anakinra is FDA approved to treat rheumatoid arthritis and neonatal-onset multisystem inflammatory disease (NOMID). Although not an FDA-approved indication, anakinra is sometimes used for systemic juvenile idiopathic arthritis, Adult-Onset Still’s Disease, gout, calcium pyrophosphate deposition (formerly called Pseudogout), Behcet’s Disease, ankylosing spondylitis, uveitis, and other auto-inflammatory syndromes.

How to Take It

For rheumatoid arthritis, the standard dose is 100mg per day injected under the skin. In children with neonatal-onset multisystem inflammatory disease (NOMID) and other auto inflammatory diseases, the dose is adjusted for patient weight. In children, the starting dose is 1-2mg/kg daily. The dose can be taken every other day in patients with decreased kidney function.  Anakinra is effective by itself. In the case of rheumatoid arthritis, anakinra can be taken with methotrexate.

Anakinra must be stored in a refrigerator and warmed to room temperature before use. A nurse or physician can teach patients how to give themselves the injections. It often helps to bring a spouse or friend along to learn how to do the injections. Anakinra can be injected in the front of the thigh or abdomen. Injection sites should be rotated so that the same site is not used repeatedly.

Anakinra relieved symptoms in four – six weeks in the clinical trials for rheumatoid arthritis. In neonatal-onset multisystem inflammatory disease, systemic juvenile idiopathic arthritis, Adult-Onset Still’s Disease, gout, and other auto-inflammatory disorders, anakinra may begin to relieve symptoms within hours.

Side Effects

The most common side effects are injection site reactions such as redness, itching, rash, and pain. Bruising or bleeding also can occur, but it is rare. These effects usually stop after one – two weeks. Headaches and low white blood cell counts also can occur, but these are very rare. Biologics, like anakinra, can increase the risk of infections. Their safety can be increased by periodic blood tests and monitoring for infection by a doctor. Patients taking anakinra should notify their doctors immediately if they develop fevers or other infection symptoms.

Anakinra has no known interactions with other medications. Anakinra should not be used at the same time as other biologics [e.g., etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), certolizumab (Cimzia), golimumab (Simponi), abatacept (Orencia), or tocilizumab (Actemra), or Rituximab (Rituxan and MabThera) This is because all biologics increase the risk for infection.

Tell Your Doctor

Anakinra blocks one of the pathways that cause inflammation. This pathway also is used to fight infections. You should tell your doctor if you aren’t feeling well, since you may have an infection. Your doctor can stop anakinra and start antibiotics, if needed.

Patients taking anakinra should not receive live vaccines, such as certain forms of the influenza vaccine, shingles, and yellow fever. Please consult your doctor beforehand.

Updated March 2017 by Alexei Grom, MD, and Stacy Ardoin, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2017 American College of Rheumatology