• Reduction of the signs and symptoms of moderately to severely active rheumatoid arthritis in patients who have failed other disease-modifying antirheumatic drugs (DMARDs) (may be used in combination with other DMARDs other than tumor necrosis factor [TNF] blocking agents).
• Neonatal-onset multisystem inflammatory disease.
• Deficiency of interleukin-1 receptor antagonist.
• Coronavirus disease 2019 (Covid-19) in hospitalized patients with positive results of direct SARS-CoV-2 viral testing with pneumonia requiring supplemental oxygen who are at risk of progressing to severe respiratory failure and are likely to have elevated levels of soluble urokinase plasminogen activator receptor (an emergency use authorization [EUA] has been issued for this use of anakinra; this drug is not FDA-approved for this use).

Contraindicated in:

• Active infections
• Hypersensitivity
• Hypersensitivity to other Escherichia coli–derived products
• OB: Pregnancy.

Use Cautiously in:

• Other chronic debilitating illness
• Underlying immunosuppression
• Renal impairment
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Safety and effectiveness not established in children with Covid-19 or juvenile rheumatoid arthritis
• Geri: Older adults may be more sensitive to toxicity due to age-related ↓ in renal function; ↑ incidence of infection.

Exercise Extreme Caution in:

• Concurrent use of TNF blocking agents such as etanercept (higher risk of serious infections).

F and E: hyperkalemia, hypernatremia.

GI: ↑liver enzymes, constipation, diarrhea, nausea.

GU: acute kidney injury.

Hemat: neutropenia.

Local: injection site reactions.

Neuro: anxiety, headache.
Misc: hypersensitivity reactions (↑ risk in patients with deficiency of interleukin-1 receptor antagonist), INFECTIONS.

Drug-Drug:

• ↑risk of serious infection with TNF blocking agents, such as etanercept.
• May ↓ antibody response to and increase the risk of adverse reactions from vaccines; avoid concurrent administration of live vaccines.

• Solution for injection (prefilled syringes): 100 mg/0.67 mL;

Rheumatoid Arthritis

• SC (Adults): 100 mg/day.

Neonatal-Onset Multisystem Inflammatory Disease

• SC (Adults and Children): 1–2 mg/kg/day given in 1–2 divided doses; may ↑ by 0.5–1 mg/kg/day, as needed (maximum = 8 mg/kg/day).

Deficiency of Interleukin-1 Receptor Antagonist

• SC (Children): 1–2 mg/kg/day; may ↑ by 0.5–1 mg/kg/day, as needed (maximum = 8 mg/kg/day).

Covid-19

• SC (Adults): 100 mg once daily for 10 days.

Kineret

• Blocks the destructive effects of interleukin-1 on cartilage and bone resorption by inhibiting its binding at specific tissue receptor sites.

• Slowed progression of rheumatoid arthritis.
• Reduction in neonatal-onset multisystem inflammatory disease symptoms.
• Achievement of inflammatory remission in deficiency of interleukin-1 receptor antagonist.
• Improved survival associated with Covid-19.

Therapeutic Classification: antirheumatics (DMARD)

Pharmacologic Classification: interleukin antagonists

Absorption: Well absorbed (95%) following SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: 4–6 hr.

(clinical response)

• Instruct patient in correct technique for injection and care and disposal of equipment. Advise patient/parent to read Patient Information and Instructions for Use prior to starting therapy and with each Rx refill, in case of changes.
• Advise patient to notify health care professional if signs and symptoms of infection (fever, sore throat, cough, headache, nausea, vomiting, abdominal pain) occur.
• Inform patient of the signs and symptoms of hypersensitivity reactions and injection site reactions (pain, erythema, swelling, purities, bruising, mass, inflammation, dermatitis, edema, urticaria, vesicles, warmth, and hemorrhage). Advise patient of appropriate actions if reactions occur.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise patients not to receive live vaccines during therapy with anakinra without consulting health care professional.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Home Care Issues: Instruct patient and family on preparation and correct technique for administration of injection and care and disposal of equipment. Caution patients and caregivers not to reuse needles, syringes, or drug product.

a-na-KIN-ra