Etanercept Anakinra

Several pro-inflammatory cytokines, such as TNFa, IL-1, IL-6, are important in the initiation and maintenance of various autoimmune diseases, such as RA, CD, and psoriasis. Thus, targeted therapies, which have been developed to inhibit their activity, have resulted in clinical improvement of these patients. Currently, there are three TNFa inhibitors (etanercept, infliximab, and adalimumab) and one IL-1 receptor antagonist (anakinra) that have been approved for the treatment of at least one of these diseases. In addition, a number of other anti-cytokine therapies are in clinical development. The TNFa antagonists will be reviewed here. 

Infections Anakinra has been associated with an increased incidence of serious infections (2%) vs placebo (less than 1%). Discontinue administration if a patient develops a serious infection. Do not initiate treatment with anakinra in patients with active infections. The safety and efficacy of anakinra in immunocompromised patients or in patients with chronic infections have not been evaluated. Coadministration of anakinra and etanercept has not demonstrated increased clinical benefit. Carefully monitor patients when considering initiation of anakinra therapy concurrently with etanercept therapy. 

Serious infections were seen in clinical studies with concurrent use of anakinra and another TNF -blocking agent, etanercept, with no added clinical benefit compared with etanercept alone. The combination of infliximab and anakinra is not recommended. 

Concurrent administration of etanercept (another TNF -blocking agent) and anakinra (an interleukin-1 antagonist) has been associated with an increased risk of serious infections, and increased risk of neutropenia and no additional benefit compared with these medicinal products alone. Other TNF -blocking agents (including infliximab) used in combination with anakinra also may result in similar toxicities. 

ANAKINRA ANTICANCER AND IMMUNOMODULATING DRUGS-ADALIMUMAB, ETANERCEPT, INFLIXIMAB t risk of bone marrow suppression Additive effect Avoid co-administration... 

Regulatory agencies have issued an important postmarketing warning of an increased risk of serious infections and neutropenia in patients who receive concomitant anakinra and etanercept (4). This warning was based on an analysis of a randomized clinical trial in 242 patients with rheumatoid arthritis, in which 7% of patients receiving concomitant treatment had serious infections, compared with none in those treated with etanercept alone. Concurrent administration of these two drugs was therefore not recommended. 

Etanercept, adalimumab, anakinra Local injection-site reactions, infection Symptoms of infection... 

DMARDs methotrexate, etanercept, infliximab, anakinra, and others... 

Cytokine inhibitors Etanercept, infliximab, adalimumab, anakinra... 

In a study in patients with active rheumatoid arthritis taking etanercept and anakinra for up to 24 weeks, serious infections occurred in 7% of patients, compared with none in patients taking etanercept alone. Neutropenia occurred in 2% of patients taking both drugs. Infections are very coimnon adverse effects of treatment with etanercept but serious infections are reported to be uncoimnon (occurring in about 1% of etanercept- and placebo-treated groups in clinical studies). - Further, the combination of etanercept with anakinra has not increased clinical benefit and the manufacturers say that concurrent use is not recommended. ... 

Infliximab inhibits the activity of tumour necrosis factor (TNFa). In clinical studies the use of anakinra with another TNFa inhibitor, etanercept , (p.l062) has been associated with an increased risk of serious infection and neutropenia and no additional benefit, when compared to the use of... 

Immunologic An IgE-mediated anaphylactic reaction has been attributed to anakinra in a 46-year-old Indian woman with rheumatoid arthritis who had had an urticarial rash and infusion reactions after three doses of infliximab, and autoantibodies, worsening Raynaud s phenomenon, and digital microinfarcts after treatment with etanercept for 1 year [83 ]. Skin prick tests were positive to both anakinra and histamine. She then had an urticarial reaction to adalimumab. 

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