Which treatment is best for Rheumatoid Arthritis?

1. Anakinra: The First Biological Agent Anakinra is a liquid that is given by an injection under the skin. It is typically supplied under the brand name called kineret, you may hear some health specialists refer to it this way. The anakinra injection belongs to a category of medicines known as ‘human interleukin-1 receptor antagonists’; these are specifically man-made proteins that are nearly identical to proteins that exist naturally in the body. They are sometimes referred to as IL-1Ra or IL-1 antagonists. Anakinra works by inhibiting the protein (interleukin-1) that may be overproduced in certain diseases. This protein (interleukin-1) leads to inflammation. By controlling the inflammation, Anakinra reduces the disease symptoms and may help in order to protect against long-term complications. Indication Anakinra (Kineret) is indicated for the treatment of active adult rheumatoid arthritis (RA) in those patients who have had inadequate response to single or multiple other Disease Modifying Anti Rheumatic Drugs (DMARDs). For UNDERSTANDING RHEUMATOID ARTHRITIS, certain points are crucial, which are as follows: • Rheumatoid arthritis mainly is a disease or illness of ups and downs. • One day, your affected joints feel pretty good. • The next, swelling as well as pain ratchet up and you can barely get out of bed. • These symptom episodes; called flares; can be unpredictable and debilitating. • Because signs/symptoms differ from person to person, health specialists have had trouble agreeing on a standard definition to guide them in treating flares. • New Rheumatoid Arthritis research hopes to develop tools to help health specialists and patients bridge these gaps in understanding. How Anakinra is Given

2. Anakinra (Kineret injection) is administered once daily as an injection under the skin (subcutaneous injection). It must be stored in a refrigerator and warmed to room temperature (for 15 to 30 minutes) before administration. The recommended dose of Anakinra is 100 mg/day, given daily by subcutaneous injection. The higher doses usually did not result in a higher response. The doses should be administered at around the same time every single day. A health specialist can teach you about how, when and where to give the Anakinra injection into the subcutaneous fat. Self-injection typically uses a small, skinny 25 or 27-gauge needle (like an insulin syringe and needle) and is supplied as a prefilled syringe. Time to Effect The anakinra 100 mg injection may take certain weeks to months before patients start to notice improvement. In Rheumatoid Arthritis, anakinra begins to work usually after week 4'th and before week 12'th. In many patients skin reactions will appear from the start but will resolve after 4'th weeks. During this time-span no clinical enhancement will be expected, but once the skin reactions subside, the clinical benefits become noticeable. Responses to anakinra may be much faster in CAPs or systemic JIA (Still’s disease). Not every patient will respond to Anakinra therapy. In case no response is observed in the initial 2 to 3 months, many existing rheumatologists will usually switch to another medicine. Side Effects Due to Anakinra The most common side effects seen with Anakinra are skin reactions, often known as “injection site reactions” or “ISRs”. Skin reactions to the Anakinra (kineret 100 mg injection ) can be seen in 30% to 70% of patients. These appear as round, red, non-painful spots generally within a couple of days of the injection and may last up to 14 days before they become faint, flaky and scaled down without leaving a scar. Rarely do they cause itching, or burning. Also common is the small risk of non serious infections; like sinusitis, bronchitis, sore throat or urinary tract infections. Such infections are a bit common in all of us, but may be more frequent with inflammatory diseases (like Rheumatoid Arthritis), prednisone use or Anakinra use. Below 5% of patients may appear to have a serious infection. Several of the rare, severe side effects observed with the TNF inhibitors (such as Enbrel or Humira) are not seen with Anakinra especially, heart failure, TB, Shingles, opportunistic infections, lupus, or multiple sclerosis. In case any of these side effects concern or apply to you, discuss them with your health specialist before you decide to not take the medication. Note: not treating out of controlled chronic inflammation associated with a disease like Rheumatoid Arthritis has vastly greater risks and bad outcomes compared with the few scary, dangerous, rare or very rare risks associated with Anakinra use. Costs The anakinra injection cost (and other biologic therapies cost) is very high and may not be sometimes affordable. Cost of these medicines may vary widely and depend on the availability of a number of brands, and that makes them affordable. Patients should discuss the cost of therapy with their health specialist. Patient Instructions Anakinra is only available by prescription and needs to be given as a self-administered subcutaneous injection. Tell your health specialist about adverse reactions that worry you, bother you or are persistent. You must not take any “live” virus vaccines (such as Shingles vaccine) while on Anakinra. Your health specialist needs to know in case you have problematic injection skin reactions, fever,

3. current or recurrent infection, sores or wounds, or in case you are taking any other biologic treatment. Tell your health specialist in case you’ve had any recent hospitalization, have a previous history of recurrent infections, pneumonia, any other serious medical complications, or plans to conceive pregnancy or undergo major surgery. Precautions • Contraindicated if hypersensitivity to Anakinra or E-coli derived proteins. • Concomitant administration of tumor necrosis factor (TNF) blocking agents, including infliximab, etanercept, or adalimumab, is not recommended because of increased risk for serious infections. • Live vaccines should not be used or administered concurrently. • Therapy should not be started in patients with active infection. In case serious infection appears during treatment, discontinue injection anakinra. • Increased risk or probability of new onset or reactivation of latent Tuberculosis. • Those patients who are with renal impairment have a potential increased probability or risk of toxicity. Source - https://indianpharmanetwork.mystrikingly.com/blog/anakinra-the-first-biological-agent