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. 2011 Feb;31(2):439-47.
doi: 10.1038/jcbfm.2010.103. Epub 2010 Jul 14.

Intravenous anakinra can achieve experimentally effective concentrations in the central nervous system within a therapeutic time window: results of a dose-ranging study

James Galea  1 , Kayode Ogungbenro, Sharon Hulme, Andrew Greenhalgh, Leon Aarons, Sylvia Scarth, Peter Hutchinson, Samantha Grainger, Andrew King, Stephen J Hopkins, Nancy Rothwell, Pippa Tyrrell
Affiliations

Intravenous anakinra can achieve experimentally effective concentrations in the central nervous system within a therapeutic time window: results of a dose-ranging study

James Galea et al. J Cereb Blood Flow Metab. 2011 Feb.

Abstract

The naturally occurring antagonist of interleukin-1, IL-1RA, is highly neuroprotective experimentally, shows few adverse effects, and inhibits the systemic acute phase response to stroke. A single regime pilot study showed slow penetration into cerebrospinal fluid (CSF) at experimentally therapeutic concentrations. Twenty-five patients with subarachnoid hemorrhage (SAH) and external ventricular drains were sequentially allocated to five administration regimes, using intravenous bolus doses of 100 to 500 mg and 4 hours intravenous infusions of IL-1RA ranging from 1 to 10 mg per kg per hour. Choice of regimes and timing of plasma and CSF sampling was informed by pharmacometric analysis of pilot study data. Data were analyzed using nonlinear mixed effects modeling. Plasma and CSF concentrations of IL-1RA in all regimes were within the predicted intervals. A 500-mg bolus followed by an intravenous infusion of IL-1RA at 10 mg per kg per hour achieved experimentally therapeutic CSF concentrations of IL-1RA within 45 minutes. Experimentally, neuroprotective CSF concentrations in patients with SAH can be safely achieved within a therapeutic time window. Pharmacokinetic analysis suggests that IL-1RA transport across the blood-CSF barrier in SAH is passive. Identification of the practicality of this delivery regime allows further studies of efficacy of IL-1RA in acute cerebrovascular disease.

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Figures

Figure 1
Figure 1
Screening and recruitment schema (black=SRFT, gray=Cambridge). IMP, investigational medicinal product.
Figure 2
Figure 2
Neutrophil count pre and days 1, 2, 3, and 7 after administration of anakinra (*P<0.05).
Figure 3
Figure 3
Predicted plasma (red lines) and cerebrospinal fluid (CSF) (blue lines) mean and interval concentration profiles, and actual plasma (red points) and CSF (blue points) for each regime. IL, interleukin.
Figure 4
Figure 4
Mean plasma (A) and cerebrospinal fluid (CSF) (B) interleukin (IL)-1RA concentrations for patients in regimes 1–5.
See this image and copyright information in PMC

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