How safe it is to treat pregnant FMF patients with Anakinra?

Background

It has been reported that anakinra, an anti-IL-1R antagonist, may be a safe alternative during pregnancy in patients with various autoinflammatory syndromes (1,2).

Objectives

To assess the safety and efficacy of anakinra in pregnant FMF patients.

Methods

Five FMF patients, treated with anakinra during pregnancy were monitored for side effects, fetal and maternal outcomes.

Results

We present five FMF cases treated with Anakinra during pregnancy due to severe protracted febrile myalgia in 3, thrombocytopenia in 1 and amyloidosis in 1. One of these cases is among the 5 patients that have been previously reported (1). Throughout pregnancy no anakinra-related adverse event was observed in any of the patients. During the postpartum period one patient had an incision-site infection and the baby of the patient with thrombocytopenia also developed low platelet count which resolved with IVIG therapy. Otherwise all patients delivered normal babies. One of the patients is still pregnant and expecting twins. All of the patients, except one with colchicine intolerance continued with daily prophylactic colchicine treatment. Anakinra was terminated shortly after birth with success in all. Pregnancy-related features are listed in Table 1.

Table 1 pregnancy-related features

Conclusions

Anakinra promises to be a safe alternative in pregnant FMF patients who are unresponsive or intolerant to colchicine. It can be administered transiently only during pregnancy and stopped after delivery.