anakinra: clinical use

Prescribing considerations

• Initiation and supervision should be by a specialist experienced in the condition being treated.
• Do not initiate during an active infection; assess recurrent-infection risk and manage serious infection according to the indication-specific product information.
• Screen for latent tuberculosis and viral hepatitis before treatment.
• Review renal function because reduced kidney function lowers anakinra clearance.
• Avoid concurrent TNF-alpha inhibition and live vaccination.
• Record the product name and batch number for biologic traceability.

Contraindications and cautions

• Hypersensitivity to anakinra, an excipient or proteins derived from Escherichia coli
• Do not initiate when the absolute neutrophil count is below 1.5 × 10^9/L

Monitoring

• Check neutrophils before treatment, monthly during the first six months and quarterly thereafter; monitor closely and discontinue if neutropenia develops.
• Monitor for infection throughout treatment.
• Consider liver-enzyme testing early in Still’s disease, especially with risk factors or symptoms of hepatic dysfunction.
• Monitor renal function and reassess the prescribed regimen if impairment is severe.
• In relevant disease, follow clinical symptoms and inflammatory markers to assess response.

Clinical pharmacology

Anakinra competitively inhibits binding of interleukin-1 alpha and beta to the type I interleukin-1 receptor. Subcutaneous bioavailability is high, the terminal half-life is approximately four to six hours, and elimination is predominantly renal.

Formulation and product differences

• Ready-to-use, graduated glass pre-filled syringe with a fixed needle
• Sterile, unpreserved and intended for single use
• Clear colourless-to-white solution; specified translucent-to-white protein particles may be present
• Syringe and needle-shield components are not made with natural rubber latex
• Contains polysorbate 80, which can cause allergic reactions

Injection

Route: Parenteral

Strengths: 100 mg