Anakinra: new preparation. Weakly effective in rheumatoid arthritis.

(1) There is no consensus on the best treatment option for rheumatoid arthritis when a first-line agent fails (most often methotrexate). Among the recent immunosuppressants, etanercept should be used before infliximab. (2) Anakinra, an interleukin-1 type 1 receptor antagonist, was recently authorised in the European Union as a second-line treatment for rheumatoid arthritis in combination with methotrexate. (3) There are no published trials comparing anakinra with other slow-acting antirheumatic drugs (especially infliximab and etanercept). In one clinical trial in patients who did not respond adequately to methotrexate, the combination anakinra + methotrexate was more effective than methotrexate + placebo on ACR 20%, ACR 50% and ACR 70% criteria, but the clinical relevance of these results is doubtful. (4) An indirect comparison suggests that etanercept is more effective than anakinra + methotrexate. (5) In a placebo-controlled trial of anakinra, 75% of patients had reactions at the injection site. Serious infections, neutropenia and anti-anakinra antibodies were also reported. There is no evidence that anakinra is any safer than etanercept. (6) Anakinra + etanercept offers no gains in efficacy, just an increased risk of severe infections. (7) Subcutaneous injections of anakinra are required daily (twice-weekly subcutaneous injections for etanercept). (8) In short, there is no argument for using anakinra as a second-line treatment for rheumatoid arthritis; it does not improve disease management.
JournalPrescrire international (Prescrire Int) Vol. 13 Issue 70 Pg. 43-5 (Apr 2004) ISSN: 1167-7422 [Print] France
PMID15148945 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Antirheumatic Agents
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Receptors, Interleukin-1
  • Sialoglycoproteins
  • Methotrexate
  • Antirheumatic Agents (therapeutic use)
  • Arthritis, Rheumatoid (drug therapy)
  • Drug Therapy, Combination
  • Humans
  • Immunoglobulin G (therapeutic use)
  • Immunosuppressive Agents (therapeutic use)
  • Methotrexate (therapeutic use)
  • Receptors, Interleukin-1 (antagonists & inhibitors)
  • Sialoglycoproteins (administration & dosage, adverse effects, therapeutic use)

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