Effectiveness and adverse effects of anakinra in treatment of rheumatoid arthritis: a systematic review.

OBJECTIVE: Rheumatoid arthritis (RA) can be described as a chronic, inflammatory, progressive, autoimmune disorder characterized by generalized inflammation of the synovial joints, which hereby triggers the progressive erosion of both cartilage and bone. Anakinra is a recombinant form of human IL-1 receptor antagonist which targets the type I IL-1 receptor. In the present systematic review, we intend to evaluate the effectiveness and adverse effects of interleukin-1 antagonists in the treatment of rheumatoid arthritis.

MATERIALS AND METHODS: The database search was carried out using PubMed (Medline), Web of Science (Clarivate), Embase, Scopus, and Cochrane Library for the existing studies. A total of 3912 relevant articles were identified as per the search strategy. Out of them, 854 duplicate records and further 3024 records were excluded after going through their titles and abstracts. Further, out of 42 articles left, we excluded 32 more articles matching our inclusion criteria and excluding the reviews and case studies. Finally, we included 10 relevant studies that focused on both the effectiveness and adverse effects of interleukin-1 antagonists during the treatment of adult patients with rheumatoid arthritis in the present analysis. Nine out of 10 included studies are randomized trials (RCT) except for 1 study, which was an extension study.

RESULTS: The results showed an ACR20 response at week 12 and were the most common primary outcome measure in the present review. Various secondary outcome measures studied were changed from baseline at week 24 in individual ACR components. ACR50 and ACR70 responses at subsequent weeks (12 and 24), ESR components, HAQ score, CRP levels, and ESR. Notably, more improvement was observed with anakinra in comparison to placebo for achieving ACR50 and ACR70 responses at 24 weeks. Premature withdrawal of participants was observed in almost all the studies. Adverse drug reactions were attributed to be the most common reason followed by loss of efficacy for withdrawal of patients from the treatment. The infectious episode was another common adverse effect observed in both anakinra and placebo groups. Some malignancies were also documented in the included researches of this systematic analysis. We observed a lower overall incidence of malignancies for the studies screened compared with that of the general population.

CONCLUSIONS: This review demonstrated that anakinra is safe, effective, and well-tolerated, with no significant difference in adverse effects compared to placebo in rheumatoid arthritis patients.