Case Studies

A closer look at the Kineret® (anakinra) patient

The following case studies illustrate the experiences of five patients with difficult-to-treat RA, and how those experiences led them to treatment with Kineret.

Read the annotated editions of two Kineret case studies.

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Discover the role Kineret has played in five examples of difficult-to-treat RA

A patient’s perspective.

Megan has been treating her multidrug-resistant RA with Kineret since 2013.

“Compared to how I felt when I was diagnosed, and during the five years after, the change is heartening.” — Megan

Signs of Inflammation

  • Severe, polyarticular joint pain
  • Severe rash (vasculitis), initially on legs and spreading
  • Fatigue
  • Fever

“These years hold some of the darkest moments of my life. I ‘failed’ one drug after another. I started slowly losing my hair, my independence, and my optimism for a future without pain.”

Treatment Failures

August 2011, aged 31:

  • Treatment initiated with NSAIDs, corticosteroids, and a traditional DMARD

2011-2013:

  • Trials with 2 additional traditional DMARDs failed
  • Symptoms partially managed with NSAIDs, corticosteroids, and original DMARD

“In my case, since beginning treatment with Kineret, the joints in my hands and my feet became less tender and painful. It has also helped control my frequent low-grade fevers, and my skin rashes have improved.”

Treatment With Kineret

June 2013:

  • Treatment with Kineret initiated based on symptom profile
  • Megan continued to receive corticosteroids and traditional DMARD

September 2013:

  • Megan reports noticeable improvement in joint pain, fever, and rash

2019:

  • Megan continues treatment with Kineret

This case represents a hypothetical patient's experience. Individual results may vary.

EXPAND Date NOTES
  • Spring 2011
    • Referred to rheumatologist for
      joint pain, rash, and fever
  • August 2011
    • Diagnosed with RA
    • Treated with NSAIDs,
      corticosteroids, and traditional
      DMARD
    Trials with 2 additional DMARDs
  • June 2013
    • Started Kineret treatment
  • 2019
    • Continues Kineret treatment

A clinical case study.

Dr. Edward Ewald relays his case of a male patient with
difficult-to-treat RA , initially diagnosed at age 49.

“The patient’s symptoms definitely improved on Kineret.... He’s not had any complaints of painful joints. He’s been under relatively good control.” — Dr. Ewald

Physician Edward Ewald, MD Adult rheumatologist Patient 49-year-old male

Symptoms

  • Moderately severe joint pain
  • Swelling and tenderness of multiple PIP and MCP joints, MTP joints, shoulders, and knees:
    • Swollen joint count: 8
    • Tender joint count: 8
  • Symmetrical polyarthritis affecting large and small joints
  • One hour of morning stiffness
  • Difficulty with day-to-day functioning
  • Positive rheumatoid factor
  • Erythrocyte sedimentation rate (ESR) of 115

Diagnosis

Rheumatoid arthritis

Treatment history

Prednisone, hydroxychloroquine

Tapers prednisone, adds nabumetone

Adds methotrexate

Initial biologic with treatment failure

Kineret® (anakinra)

“We talked about Kineret because it had a very short half-life.”

Complicating Conditions

  • Poststreptococcal glomerulonephritis
  • Successful renal transplant
  • Current osteoarthritis at age 73

Results With Kineret

  • Swollen joint count: 0
  • Tender joint count: 0
  • ESR: 2
  • CRP: 6.20

This case represents a hypothetical patient's experience. Individual results may vary.

EXPAND Date NOTES
  • 1994
    • Diagnosed with RA
    • Prescribed prednisone and hydroxychloroquine
    • Patient refused methotrexate
    • After 9 months, tapered off prednisone, continued hydroxychloroquine, and began nabumetone
    • Symptoms persisted
  • 2000
    • Began treatment with methotrexate
    • Symptoms persisted
  • 2001
    • Began treatment with initial biologic
    • Experienced intermittent pain and swelling
  • 2003
    • Hospitalized for group A strep infection in foot
    • Renal failure
    • Kidney biopsy showed poststreptococcal glomerulonephritis
    • Stopped treatment with biologic
    • Started hemodialysis
  • 2005
    • Renal transplant
    • Ended hemodialysis
    • Began treatment with Kineret
    • Symptoms improved (swollen and tender joints)
  • 2019
    • Continues Kineret treatment

A nurse’s story.

Peggy, a registered nurse living with difficult-to-treat RA, treats her symptoms with Kineret.

Peggy’s symptoms began at a busy time in her life.

“My symptoms started in 1993, the day before my daughter’s fifth birthday. I started to get really achy, almost flu-like. I got up in the morning with difficulty moving anything.... As time went on I continued to work, because if you’re not getting better, you just have to go with it. I wasn’t a complainer, but people could see that I was suffering.”— Peggy

For years, doctors were unable to find a treatment that worked for Peggy.

“I tried many different treatments to get my symptoms under control, but many of them didn’t work for me and I had a hard time tolerating them.... I started to worry. What if nothing could help me?”

But her rheumatologist was unwilling to give up.

“With multiple therapeutic failures, my rheumatologist continued her search for a treatment. She attended a rheumatology conference and with me and my RA diagnosis in mind, she came back and said ‘I have something for you.’ That’s when I started Kineret.”

Peggy experienced a reduction in her symptoms after starting Kineret.

“The fatigue and the aching in my joints started to improve.... My RA symptoms abated within 12 weeks, and didn’t return as long as I was compliant with the dosage and the maintenance schedule.”

This case represents one patient’s experience. Individual results may vary.

Altering the rheumatoid arthritis (RA) regimen

The case of a 46-year-old woman with a 3-year history of RA who achieved measurable RA improvement after starting on Kineret.

Signs and Symptoms

  • 6 swollen joints, 12 tender joints1
  • Erythrocyte sedimentation rate (ESR): 28 mm/hr2
  • General health (visual analogue scale, VAS): 503
  • Headache4
  • Debilitating fatigue2

Diagnosis

Rheumatoid arthritis

Treatment history

Prescribed MTX and short-term, low-dose corticosteroid5

Short-course steroids to treat flares5

Anti-TNF with MTX x 25

Kineret with MTX6,7

Complicating Conditions

  • Failed to ever achieve a satisfactory response
  • Poor response to steroids8
  • Persistent flares, including signs/symptoms associated with autoinflammation2

Results With Kineret

  • Christine is prescribed Kineret6
  • Anti-TNF is stopped and MTX continued6
  • Christine has symptomatic relief and improvement in ESR6
  • Christine remains on Kineret and MTX; RA symptoms continue to be well managed2,6-7

This case represents a hypothetical patient’s experience. Individual results may vary.

EXPAND Date NOTES
  • 1994
    • Diagnosed with RA
    • Prescribed MTX and short-term, low-dose corticosteroid5
    • Experienced initial symptom improvement
  • 2000
    • Persistent joint pain, fatigue, and fevers; short-course steroid prescribed to address flares but minimal impact2 and evidence of elevated glucose
    • Initiated anti-TNF treatment with MTX, resulting in partial relief5
    • Symptoms returned, switched to another anti-TNF5
  • 2001
    • Diagnosed with diabetes, well managed with metformin9
    • Persistent fever with rash and headache4
    • Autoinflammatory etiology suspected2
    • Discontinued anti-TNF
    • Initiated treatment with Kineret + MTX6
  • 2003
    • Continues successfully managing her RA with Kineret and MTX

Adding Kineret to a complicated case

A look at how one 60-year-old RA patient with accompanying complicating conditions found success with Kineret.

Signs and Symptoms

  • 3 swollen joints, 16 tender joints1
  • C-reactive protein (CRP): 40 mg/dL10
  • General health (VAS): 603
  • Mild bone erosion on radiograph11
  • Dry eyes, recurrent fevers, and fatigue2,4
  • Complicating conditions: obesity, diabetes, hypertension, and dyslipidemia

Diagnosis

Rheumatoid arthritis

Treatment history

DMARD monotherapy5

DMARD combination therapy5

Anti-TNF + MTX x 25

non-TNF biologic5

Kineret + MTX6

Complicating Conditions

  • Multiple complications
  • After several failed attempts at control, success with anti-TNF + MTX complicated by signs of fluid overload (dyspnea) and suspected acute heart failure17,18
  • Anti-TNF discontinued, resulting in exacerbation of autoinflammatory signs and symptoms11

Results With Kineret

  • Kineret added to MTX; symptomatic response restored6
  • CRP improved (10 mg/dL)6
  • Radiograph showed no significant progression of bone erosion6
  • Symptomatic benefit achieved6

This case represents a hypothetical patient’s experience. Individual results may vary.

EXPAND Date NOTES
  • 1994
    • Diagnosed with RA
    • Prescribed DMARD monotherapy5
  • 2000
    • Signs and symptoms persist and worsen
    • Initiates and fails series of approaches: DMARD combination, followed by anti-TNF with MTX5
    • Switched to second anti-TNF (with MTX)5
  • 2001
    • Diagnosed with acute heart failure; anti-TNF discontinued,12-16 with loss of RA control17-18
    • Non-TNF biologic prescribed
    • Worsening joint pain
    • Recurrent fevers, headache, and rash4
    • Elevated CRP10
    • Autoinflammatory etiology suspected2
    • Initiates Kineret with MTX6
    • Resolution of autoinflammatory symptoms with good pain control6
    • CRP improves6
  • 2003
    • Continues successfully managing his RA with Kineret and MTX
    • Occasional flares managed with short-course steroids5
    • Patient reports fewer fevers and less fatigue2,6
    • No significant progression of bone erosion noted on radiographs6