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Kineret (Anakinra) & MTX

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New Treatment for Rheumatoid Arthritis:

http://www.medscape.com/viewarticle/436308

Anakinra (Kineret), an antagonist of the interleukin-1 receptor, recently was

FDA approved for treatment of rheumatoid arthritis (RA). In this

manufacturer-sponsored, double-blind, randomized trial, investigators examined

the efficacy of anakinra in combination with methotrexate.

A total of 419 patients with active RA, despite at least 6 months of

methotrexate therapy, received either placebo or anakinra, injected

subcutaneously at doses that ranged from 0.04 mg/kg to 2.0 mg/kg. Methotrexate

was continued in all patients. At 12 weeks, the proportion of patients who

achieved an ACR20 response (i.e., a 20% reduction in a score that reflects

several subjective and objective measures) was significantly higher among those

who received 2.0-mg/kg or 1.0-mg/kg anakinra than among those who received

placebo (38% and 46% vs. 19%). At 24 weeks, the percentage of responders

remained significantly higher among 1.0-mg-anakinra recipients than among

placebo recipients (42% vs. 23%). The most common adverse events were

injection-site reactions. Five of 345 anakinra recipients withdrew because of

leukopenia, which resolved in all cases.

Comment

Anakinra is the latest biologic agent to be approved for use in RA, joining the

2 therapies that target tumor necrosis factor-a (infliximab [Remicade] and

etanercept [Enbrel]). Upon reviewing studies of these agents in combination with

methotrexate, editorialists conclude that the efficacy of anakinra " is generally

similar " to that observed with infliximab and etanercept. If this assertion is

true, then the choice between therapies will depend heavily on their relative

costs and side-effect profiles.

- Allan S. Brett, MD

Source

Cohen S et al. Treatment of rheumatoid arthritis with anakinra, a recombinant

human interleukin-1 receptor antagonist, in combination with methotrexate:

Results of a twenty-four-week, multicenter, randomized, double-blind,

placebo-controlled trial. Arthritis Rheum 2002 Mar; 46:614-24.

Dayer J-M and Bresnihan B. Targeting interleukin-1 in the treatment of

rheumatoid arthritis. Arthritis Rheum 2002 Mar; 46:574-8.

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