P018 A review of the use of anakinra in hyperinflammatory conditions at a large central London teaching hospital
Authors: Munro Isabelle , Allen Rachel , Jones Alexis , Manson Jessica 
Published: April 2024

Abstract

Background/Aims
The interleukin-1 receptor antagonist, anakinra, is increasingly used to treat inflammatory disorders. We recognized a need to provide patients with accurate information regarding the trajectory of their treatment. In this service evaluation project, we collected data on patients prescribed anakinra at a London teaching hospital over a 4-year period.

Methods
Patients included were started on anakinra to manage an inflammatory disorder between April 2019 and Feb 2023. Patients were identified by searching a high-cost drugs system. Data on indication for the drug, start and stop date(s) of treatment and any adverse effects were then collected using electronic patient records.

Results
74 patients met inclusion criteria, 43 females and 31 males. Median age 38.5 years. 56 patients were treated for haemophagocytic lymphohisticytosis (HLH), 5 for Juvenile Idiopathic Arthritis (JIA) and 13 for Adult Onset Still’s Disease (AOSD). Median time on anakinra was 140.5 days (IQR 563.5), 1487.5 days (IQR 861) and 673 days (IQR 1017) for HLH, JIA and AOSD respectively. Of those treated for HLH, drivers and median duration of anakinra treatment for each respective driver were: infection (seven patients, 31 days), rheumatological (six patients, 785 days), haematological (26 patients, 36.5 days), iatrogenic (1 patient, 89 days), primary HLH (2 patients, 89 days), underlying rheumatological condition with infective/drug trigger (3 patients, 345 days), unknown (11 patients, 191 days). 9/56 patients with HLH remained on treatment at data collection - 4 with an unknown driver, two with AOSD, one with underlying Sjogren’s and a drug trigger, one with a haematological driver and one with primary HLH. 12/56 patients with HLH had died. Of those who died, eight had a haematological malignancy driving their condition, three had an infective driver and one an unknown driver. Five patients in our study had HLH driven by AOSD. Of these, 2/5 successfully stopped anakinra during the study period. Five patients (8.9%) with HLH required multiple courses of treatment with anakinra; three had lymphoma associated HLH, one primary HLH and one idiopathic HLH. Three patients were unable to continue with therapy due to side effects: neutropenia(1), rash (1), problems self-injecting (1).

Conclusion
From this data set we can begin to formulate answers to many commonly encountered questions regarding anakinra therapy. The length of time someone can expect to receive treatment with anakinra is significantly impacted by the indication for prescribing. Those with a haematological malignancy driving their HLH receive anakinra for the shortest time of all groups, usually while awaiting definitive treatment for their cancer, or before transition to palliative management. Some patients with AOSD driven HLH can safely stop treatment. Some patients may require multiple courses of treatment with anakinra for disease relapse. Adverse effects requiring treatment cessation are low in all groups.

Disclosure
I. Munro: None. R. Allen: None. A. Jones: None. J. Manson: None.