Anakinra helps stroke patients reduce harmful inflammation

The drug anakinra has been found to reduce harmful inflammation in the early stages of stroke, according to fresh research from Manchester University and the Salford Royal NHS Foundation.

 The biopharmaceutical was studied in ischemic stroke cases

The drug anakinra has been found to reduce harmful inflammation in the early stages of stroke, according to fresh research from Manchester University and the Salford Royal NHS Foundation. 

The biopharmaceutical anakinra, known by its commercial name Kineret©, was to this point licensed for the treatment of rheumatoid arthritis. It is given as a small subcutaneous injection without any identifiable adverse reactions. Anakinra is now changing treatment methods for a wide array of conditions.

Understanding the relationship between the IL-1 protein and strokes

Interleukin-1 (IL-1), a protein that is part of the body's defense mechanisms, is naturally produced to combat many illnesses. University of Manchester scientific research has previously looked at how IL-1 increases brain injury and inflammation after a stroke. Such episodes occur when weak blood flow to the brain causes cell death. Strokes can be mainly ischemic (due to lack of blood flow) and hemorrhagic (due to bleeding occurring in the brain). Worldwide, strokes are one of the most common causes of death and disability in adults.

Manchester University Professor Craig Smith, a stroke physician, explained that although strokes affect patients in different ways, the aftermath can have debilitating effects on general well being and long-term health. More problematic, the presence of inflammation in stroke episodes are found to predict a worse outcome in sufferers. Anakinra’s usefulness was tangible as the biopharmaceutical was found to block the actions of IL-1, which is naturally released into the body after a stroke-caused injury. 

Experiment design

The experiment consisted of a double-blind trial where anakinra (in this specific case applied in its commercial form Kineret) was tested against a placebo and focused only on ischemic stroke patients. 80 study participants in the study were given 6 doses of the drug or placebo in a three-day period. A first dose was administered within 6 hours from the onset of stroke symptoms. Inflammatory markers were measured in the blood prior and during the treatment.

Usefulness for treating inflammation

This experiment follows prior studies that show how intravenous anakinra administration reduces stroke inflammation and helps subarachnoid hemorrhage. This study’s research team confirmed Kineret’s role in reducing inflammation and its safety in patients with subarachnoid hemorrhage.

In the onset of stroke, anakinra can be provided quickly, via injection or drip and therefore can be used in many contexts, such as in ambulatory care or emergency transportation like ambulances. This is of particular relevance for stroke cases, as the brain may lose up to 2 million brain cells for every minute of stroke. The quick availability of such a drug is a great improvement in effective stroke treatment. The research team, however, is less certain at this stage on how the drug’s impact on inflammation reduction will affect clinical outcomes.

Limitations and opportunities

On that line of thought, the research team is aware that their study has not yet proven the possibility that anakinra could reduce post-stroke patient disability. Yet, with any further trials, the hope is that the impact of the drug in improving outcomes and quality of life for stroke patients can be fully discovered. More research is therefore needed from this point on to determine if drugs like Kineret can be not only an effective treatment for ischemic stroke but also if it can be administered in parallel to treatments including drugs used to manage thrombolysis cases.

Upcoming research

In order to unfold the full potential of Kineret, the Medical Research Council and National Institute for Health Research, England, will fund and begin in 2018 a national trial of 1000 patients to determine any improvement in conditions of subarachnoid hemorrhage. A further trial of 80 stroke patients of intracerebral hemorrhage stroke will begin this year, this time to test safety for Kineret administration in these type of strokes. 

SCIL-STROKE (Subcutaneous Interleukin-1 Receptor Antagonist in Ischemic Stroke)
Craig J. Smith, Sharon Hulme, Andy Vail, Calvin Heal, Adrian R. Parry-Jones, Sylvia Scarth, Karen Hopkins, Margaret Hoadley, Stuart M. Allan, Nancy J. Rothwell, Stephen J. Hopkins and Pippa J. Tyrrell
Stroke. 2018; STROKEAHA.118.020750, originally published March 22, 2018