NICE Recommends Anakinra for Paediatric and Adult-onset Still’s Disease

Pavankumar Kamat

April 01, 2021

The National Institute for Health and Care Excellence (NICE) has recommended anakinra (Kineret, Swedish Orphan Biovitrum) as a treatment option for Still’s disease in adults and systemic juvenile idiopathic arthritis in children.

Anakinra is an interleukin-1 receptor antagonist and is recommended for the treatment of patients with Still's disease who have moderate to high disease activity or patients who continue to have active disease despite treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or glucocorticoids. Patients eligible for anakinra include:

  • Those with adult-onset Still's disease having inadequate response to two or more conventional disease-modifying antirheumatic drugs (DMARDs).

  • Those with systemic juvenile idiopathic arthritis (age, ≥8 months; weight, ≥10 kg) having inadequate response to at least one conventional DMARD.

The recommended dose for adults and children weighing ≥50 kg is 100 mg/day administered subcutaneously. For adults and children weighing <50 kg, a starting dose of 1-2 mg/kg/day is suitable. The dose can be increased up to 4 mg/kg/day for children with inadequate response.

Clinical evidence regarding the efficacy of anakinra after treatment with NSAIDs and corticosteroids remains highly uncertain, but it can be reasonably assumed to be as effective as tocilizumab. Furthermore, anakinra and tocilizumab appear to have similar weekly treatment costs for the recommended indications.

The recommendations should not affect patients whose treatment with anakinra was started before the publication of the guidance.

Commenting in a company news release, Paul Brogan, professor of vasculitis and speciality lead, paediatric rheumatology, Great Ormond Street Hospital Institute for Child Health, said: "This final NICE guidance endorses that clinicians have the flexibility to use anakinra earlier in the patient pathway, as a first-line biologic therapy, which is something specialists in this area welcome and brings us closer to quicker disease control that would prevent progressive joint and systemic damage."

This article was adapted from Univadis, part of the Medscape Professional Network.

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