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IL-1 Receptor Antagonist Pregnancy: B

Anakinra

Brand names: Kineret

Adult dose

Dose: 100 mg SC once daily
Route: subcutaneous injection
Frequency: once daily
Max: 100 mg/day
Pre-filled syringe with 27-gauge needle; rotate injection sites; refrigerate at 2–8°C; use within 30 min of removing from fridge

Paediatric dose

Dose: 1 mg/kg
Route: subcutaneous
Frequency: once daily
Max: 8 mg/kg/day (sJIA)
Concentration: 150 mg/mL mg/ml
sJIA: 1–2 mg/kg once daily SC (max 100 mg); NOMID/DIRA: higher doses; Cryopyrin-associated periodic syndrome

Dose adjustments

Renal

Reduce to every other day if eGFR <30 ml/min

Hepatic

No dose adjustment required

Paediatric weight-based calculator

sJIA: 1–2 mg/kg once daily SC (max 100 mg); NOMID/DIRA: higher doses; Cryopyrin-associated periodic syndrome

Clinical pearls

  • Short half-life (4–6h) — daily injection required; high injection site reaction rate limits long-term adherence
  • Preferred for CAPS, DIRA, sJIA flares, adult-onset Still's disease, and macrophage activation syndrome
  • ANAJUSS study: effective in COVID-19 hyperinflammation (IL-1 pathway implicated)

Contraindications

  • Active infections (especially sepsis)
  • Neutropenia (ANC <1.5 × 10⁹/L)
  • Live vaccines

Side effects

  • Injection site reactions (60–75% — most common)
  • Infections (serious bacterial)
  • Neutropenia
  • Thrombocytopenia
  • Headache

Interactions

  • TNF inhibitors (avoid — ANAKINRA trial: no additional benefit, threefold serious infections)
  • Live vaccines (CI)

Monitoring

  • FBC with neutrophil count (monthly × 3 months, then quarterly)
  • Signs of infection
  • Injection site reactions

Reference: BNFc; BNF 86; NICE TA71; BSR biologics guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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