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Pharmacology · Interleukin inhibitors

Anakinra !

A copy of the body's own IL-1 blocker, injected under the skin every day, for rheumatoid arthritis and inherited autoinflammatory diseases.

Updated 2026-11-01

The figure shows the IL-1 receptor bound to the natural IL-1 receptor antagonist (IL-1Ra); anakinra is a recombinant form of that same protein.

Target in 3D: Interleukin-1 receptor type 1 (IL-1R1). PDB structure 1IRA (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Anakinra is a recombinant, non-glycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). It occupies the type 1 IL-1 receptor without activating it, so IL-1α and IL-1β cannot signal. This turns down fever, the acute-phase response and cartilage breakdown. The body makes IL-1Ra naturally, but not enough to offset the excess IL-1 of inflammatory disease.

  1. Recombinant IL-1 receptor antagonist
  2. Sits on IL-1R1 without activating it
  3. IL-1α and IL-1β cannot signal
  4. Less fever and inflammation

Pharmacokinetics

Absorption
Subcutaneous injection
Elimination
Kidney disease is taken into account before and during treatment

Indications

Adverse effects

Common

  • Injection-site redness, swelling, bruising or itching
  • Headache
  • Nausea, vomiting, diarrhoea, abdominal pain
  • Runny nose; joint pain

Contraindications

  • Hypersensitivity to anakinra
  • Active serious infection

Key interactions

TNF inhibitors (etanercept and others)
More serious infections without added benefit; not combined.
Live vaccines
Risk of infection from the vaccine strain; avoided during treatment, and vaccines are updated before starting.

What is monitored

  • Signs of infection
  • Latent tuberculosis test before starting
  • Blood tests before and during treatment, as ordered
  • Kidney function

Administration and safety

  • Subcutaneous injection from a prefilled syringe, rotating sites.
  • The first dose is usually given in the clinic, with teaching for home injection.

Nursing care

  • Before the first dose, confirm the latent tuberculosis test (and hepatitis B screening where ordered) and that vaccines are up to date.
  • Do not give the dose during an active infection; teach to report fever, cough, burning on urination or hot, red skin.
  • Live vaccines are avoided during treatment; any vaccine is discussed with the team first.
  • Ask about kidney disease.

Pregnancy and breastfeeding

Human data are limited; the treating team weighs benefits and risks.

Test yourself

Think of the answer, then tap the question to see it.

What natural protein is anakinra a copy of?

The interleukin-1 receptor antagonist (IL-1Ra), which blocks the IL-1 receptor without activating it.

Why is anakinra not combined with etanercept?

The combination raises serious infections without improving rheumatoid arthritis.

Which group of diseases responds especially well to IL-1 blockade?

Autoinflammatory syndromes such as neonatal-onset multisystem inflammatory disease (a cryopyrin-associated syndrome) and DIRA.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Anakinra: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 39 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.