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[Treatment of rheumatoid arthritis by interleukin-1 receptor antagonist]
1Service de rhumatologie, centre hospitalier universitaire Jean-Minjoz, 25030 Besançon cedex, France. daniel.wendling@ufc-chu.univ-fcomte.fr
Purpose:
Interleukin -1 receptor antagonist ( IL-1Ra ) is a new option among biotherapies against rheumatoid arthritis ( RA ).
The Aim:
of this review is to recall the rationale of use of IL-1Ra and to analyse the results available in the current literature.
Current Knowledge And Key Points:
Pathophysiological data of RA give a specific position for IL-1 as a potential target for immunotherapy in this disease, confirmed in animal models. Phase II and III studies with IL-1Ra (Anakinra) demonstrated clinical efficacy versus placebo (42% responders in ACR 20 in Anakinra + methotrexate, and 23% in the placebo + methotrexate group at 24 weeks) and a structural effect (slowing of radiological progression at six months). Anakinra has obtained an European license and is indicated in RA not controlled by methotrexate, in daily subcutaneous administration (100 mg/day), in combination with methotrexate. Tolerance is fair; the most frequent side effect is represented by injection site reactions.
Future Prospects And Projects:
This ambulatory biotherapy offers new perspectives in combination with other slow acting drugs as well as biologic agents such as anti-TNF, currently under evaluation.