Drug2nd line5 diseases
Anakinra
IL-1 receptor antagonist
- Response rate
- ~80-90%
- Onset
- Hours to days
- Route
- SC 100 mg daily
- Line
- 2nd
- IgM effect
- Rapid ferritin reduction
- Evidence level
- green
Used across diseases
| Disease | Response rate | Line | Evidence |
|---|---|---|---|
| Adult-Onset Still's Disease | ~80-90% | 2nd | green |
| Cryopyrin-Associated Periodic Syndromes | Sustained efficacy up to 5 years | 1st | green |
| Familial Mediterranean Fever | 76.5% complete response | 2nd | green |
| Schnitzler Syndrome | ~94% | 1st | green |
| TNF Receptor-Associated Periodic Syndrome | ~90% (complete ~67%) | 1st | green |
Evidence summary
Recombinant IL-1 receptor antagonist with rapid onset of action. Fever and systemic symptoms often resolve within hours to days. The first RCT (Nordstrom et al. 2012) demonstrated greater remission rates vs DMARDs. Long-term retention rate is excellent with cumulative loss-of-efficacy risk of only 3.4% at 12 months and 13.5% at 60 months. EMA-approved for AOSD. Particularly effective for the systemic phenotype. Expert consensus is shifting toward early biologic use to reduce steroid burden.
Molecular targets
| Molecule | Role | Expression | Evidence |
|---|---|---|---|
| IL-1β | Central pro-inflammatory cytokine driving systemic inflammation | Elevated | established |
Sources (4)
DetailsNordstrom D et al. (2012) Beneficial effect of interleukin 1 inhibition with anakinra in adult-onset Still's disease: an open, randomized, multicenter studyPubMed ↗