A New Kid On The Block
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Leslie J. Schoenfield, MD, PhD
A new drug is available for adult patients with moderate to severe rheumatoid
who have not responded to other disease modifying antirheumatic drugs
(DMARDs)! The brand name of the new drug is Kineret and its generic name is
This is big news in the treatment of rheumatoid arthritis. You see, anakinra
(Kineret) is a new type of biological response modifier (BRM) for treating this
disease. Thus, anakinra (Kineret) acts by blocking the biological effects of the
chemical messenger, Interleukin-1 (IL-1). IL-1 is a protein that is produced by
many cells in the body. It is found, however, in increased amounts within joints
that are inflamed by rheumatoid arthritis. In fact, IL-1 promotes the
inflammation and destruction of cartilage and bone in rheumatoid arthritis.
Accordingly, this BRM, like the traditional DMARDS, can prevent progressive
What are advantages of Kineret?
- Anakinra (Kineret) may be used alone or in combination with methotrexate
(Rheumatrex) or other DMARDs.
- To date, no cases of the activation of tuberculosis or other opportunistic
infections (such as serious fungus infections) have been reported with the use
of anakinra (Kineret). In contrast, opportunistic infections have been reported
with another type of BRM drugs that includes infliximab (Remicade) and
(Enbrel). (These biological response modifiers work by blocking another of the
body's promoters of joint inflammation called tumor necrosis factor, TNF).
- Patients can become intimately involved in their own
treatment by self-injecting anakinra (Kineret) under the skin.
- Patients will have the option of self-injecting 100 mg prefilled syringes
or loading these into a specially designed injector device, called the
What are disadvantages of Kineret?
- Anakinra (Kineret) must be injected into the skin
- The primary adverse event noted in clinical trials
was local skin irritation at the injection site. Other infrequent side effects
included mild reductions in white blood cell counts, headache, and an increase
in respiratory infections.
- Low white blood cell counts have been reported when
anakinra (Kineret) is combined with the TNF-blocking drugs (infliximab and
etanercept). Moreover, when combined with the TNF-blockers, anakinra (Kineret)
was associated with a significant increase in serious infections. (White blood
cells help fight infections.)
- Patients are advised to keep anakinra (Kineret) refrigerated at 2-8
degrees C (36-48 degrees F) until planned use at room temperature.
Dr. Shiel's perspective
Anakinra (Kineret) is an effective and relatively safe drug that has been
studied in thousands of rheumatoid arthritis patients to date. While no data
exists that directly compares anakinra (Kineret) with other agents in treating
rheumatoid arthritis, it appears that the effectiveness rates of this drug in
studies to date are comparable to existing DMARDs and biologic drugs.
Furthermore, the Simpleject™ system of administration is relatively easy to
use, even for patients with significant hand deformity.
So, which rheumatoid arthritis patients should receive this drug? First of
all, I will offer anakinra (Kineret) to patients who have not responded to other
disease modifying antirheumatic drugs (DMARDs). Thus, I will consider anakinra (Kineret)
for patients who have not responded to traditional DMARDs, or do not want to use
intravenous treatment with infliximab (Remicade), or cannot get etanercept (Enbrel)
because of lack of insurance coverage. I will certainly also consider anakinra (Kineret)
for patients with moderate to severe rheumatoid arthritis who have failed
infliximab (Remicade) or etanercept (Enbrel).
Anakinra (Kineret) might be considered in patients with rheumatoid arthritis
who have experienced a serious reaction (side effect) to another BRM agent (infliximab/Remicade
or etanercept/Enbrel). Also, be aware that aggravation of congestive heart
failure has been reported to be associated with infliximab usage. Therefore,
anakinra (Kineret) may be an option for rheumatoid arthritis patients who have
known significant heart disease. Finally, I personally will not prescribe
anakinra (Kineret) together with the TNF-blocking drugs until more information
is available to verify the safety of this combination.
It is noteworthy that at our recent national meeting of arthritis experts,
the American College of Rheumatology, anakinra (Kineret) was shown to improve
the functional status (ability to perform various physical activities) of
patients with rheumatoid arthritis. In another study, anakinra (Kineret) was
demonstrated to significantly improve the number of productive days at work and
domestic home activity in patients with rheumatoid arthritis. This is important information
because, after all, these are ultimately critical measures of successful treatment.
For more information, please read the Kineret drug monograph.Last Editorial Review: 7/6/2004