Is Anakinra (Kineret) Safe for Pregnant Women with Rheumatoid Arthritis (RA)?

Last Editorial Review: 8/27/2020

Ask the Experts

My husband and I have finally decided to start trying to have a baby, despite the fertility problems caused by my rheumatoid arthritis

We have been putting it off because I only recently found the right combination of medications that keeps my severe RA symptoms under control. The addition of Kineret to the DMARD I was already taking seemed to cut down the number and severity of my RA flares right away, and it was such a relief.

Now that I finally feel I can function normally again, I worry that adjusting my medication regimen to protect my baby from birth defects means a return to my days of painful RA flares.   

Can I keep taking Kineret, even while we’re trying to conceive and while I am pregnant?

Doctor’s Response

Retrospective studies in humans and animal studies have suggested no increased risk of fertility problems, birth defects or miscarriage in women taking Kineret for rheumatoid arthritis during pregnancy, according to the U.S. Food and Drug Administration. 

In fact, poorly controlled RA, itself, can lead to health problems in the newborn.

That does not mean there is no risk for pregnant women taking Kineret, however. None of the drugs used in the treatment of rheumatoid arthritis (RA) is completely safe during pregnancy. You must discuss with your physician regarding the decision to use, modify, or stop any medications. 

Many pain medications, for example, should be stopped immediately upon finding out you are pregnant. Certain other drugs such as azathioprine and abatacept are used in the treatment of RA in pregnant women only if the risks of side effects are outweighed by the benefits of these drugs. These drugs have been found to cause fetal defects in a few studies.

Kineret reduces signs and symptoms and slows the progression of structural damage in rheumatoid arthritis in adults who have failed one or more disease modifying antirheumatic drugs (DMARDs), according to the FDA. The drug is a synthetic form of human interleukin-1 receptor antagonist (IL-1Ra), a substance naturally produced in the body.

Kineret can be used alone or in combination with DMARDs other than Tumor Necrosis Factor (TNF) blocking agents, the FDA states.

The good news is the majority of women with RA experience a remission of symptoms during pregnancy. Conditions of pregnancy suppress the immune system, cause release of anti-inflammatory compounds and tend to generally cause RA remission. 

Beware, however; a significant minority of women actually experience worsening symptoms of RA with pregnancy. In these cases, the disease itself can cause low birth weight and, rarely, CAPS (cryopyrin-associated periodic syndromes) in the infant, according to 

Watch out for a potential recurrence of symptoms in the three weeks after delivery, as well. 

Once again, you and your doctor should discuss the use of any drugs you use to treat RA, ideally before pregnancy.


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