title: Anakinra: new preparation. Weakly effective in rheumatoid arthritis.
abstract: (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.
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D012795:Sialoglycoproteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D017472:Receptors, Interleukin-1; D012795:Sialoglycoproteins; D008727:Methotrexate