Prospecto: information for the user

Kineret100mg/0.67ml injectable solution in pre-filled syringe

Anakinra

Read this prospect carefully before starting to use this medication, as it contains important information for you.

• Keep this prospect, as you may need to read it again.

• If you have any doubts, consult your doctor or pharmacist.

• This medication has been prescribed only to you, and you should not give it to other people even if they have the same symptoms as you, as it may harm them.

• If you experience any adverse effects, consult your doctor or pharmacist, even if they are not listed in this prospect. See section 4.

1.What is Kineret and for what it is used

2.What you need to know before starting to use Kineret

3.How to use Kineret

4.Possible adverse effects

5.Storage of Kineret

6.Contents of the package and additional information

Kineret contains the active ingredient anakinra. It is a type of cytokine (an immunosuppressant agent) used to treat:

• Rheumatoid Arthritis (RA)
• Covid-19 in patients with pneumonia, who require supplemental oxygen and have a risk of pulmonary insufficiency
• Periodic fever syndromes:

-Periodic syndromes associated with cryopyrin (CAPS)

• Neonatal-onset multisystem inflammatory disease (NOMID)/chronic infantile neurologic, cutaneous, and articular (CINCA) syndrome
• Muckle-Wells syndrome (MWS)
• Familial cold autoinflammatory syndrome (FCAS)

• Familial Mediterranean fever (FMF)

• Still's disease, including juvenile idiopathic systemic arthritis (JIAS) and adult-onset Still's disease (AOSD)

Cytokines are proteins produced by our body that coordinate cell communication and help control cellular activity. In RA, CAPS, FMF, Still's disease, and Covid-19 pneumonia, the body produces an excessive amount of a cytokine called interleukin-1. This leads to harmful effects causing inflammation and resulting in disease symptoms. Normally, the body produces a protein that blocks the harmful effects of interleukin-1. The active ingredient in Kineret is anakinra, which acts similarly to the natural protein that blocks interleukin-1. Anakinra is obtained through recombinant DNA technology using the microorganism E. coli.

In RA, Kineret is used to treat disease signs and symptoms in adults (18 years of age and older) in combination with another medication called methotrexate. Kineret is intended for patients whose response to methotrexate alone is not sufficient to control rheumatoid arthritis.

In Covid-19, Kineret is used to treat hyperinflammation associated with the disease in adults (18 years of age and older) who have pneumonia, require supplemental oxygen to help them breathe (low or high oxygen flow), and have a risk of pulmonary insufficiency.

In CAPS, Kineret is used to treat inflammation signs and symptoms associated with this disease, such as rash, joint pain, fever, headache, and fatigue, in both adults and children (8 months of age and older).

In FMF, Kineret is used to treat inflammation signs and symptoms associated with this disease, such as recurrent fever, fatigue, abdominal pain, muscle or joint pain, and rash. Kineret can be used in combination with colchicine, as needed.

In Still's disease, Kineret is used to treat inflammation signs and symptoms associated with this disease, such as rash, joint pain, and fever.

No use Kineret

• If you are allergic to anakinra or any of the other components of this medication (listed in section6)

• If you are allergic to other products produced by DNA recombinant technology that use the microorganismE.coli

• If you have neutropenia (low white blood cell count) determined after a blood test.

Contact your doctor immediately

• If you experience a rash all over your body, difficulty breathing, wheezing, rapid pulse, or sweating after injecting Kineret. These may be symptoms of an allergic reaction to Kineret.
• If you have ever had a generalized atypical rash or skin peeling after taking Kineret.

Warnings and precautions

Consult your doctor before starting to use Kineret:

• If you have a history of recurrent infections or if you have asthma, as Kineret may worsen these conditions

• If you have cancer. Your doctor will have to decide if you can receive Kineret
• If you have a history of elevated liver enzyme levels
• If you need to be vaccinated. You should not be vaccinated with live vaccines while being treated with Kineret.

Still's disease

• In rare cases, patients with Still's disease, especially children, may develop lung disease, also during treatment with Kineret. The risk may be increased in patients with Down syndrome (trisomy21). Symptoms of lung disease may include, for example, shortness of breath during light exercise, morning cough, and difficulty breathing. If you develop symptoms of lung disease, contact your doctor as soon as possible.
• Rarely, a severe skin reaction, DRESS (drug reaction with eosinophilia and systemic symptoms), has been associated with treatment with Kineret, especially in patients with systemic juvenile idiopathic arthritis (AIJS). Seek medical attention immediately if you observe a generalized atypical rash, which may appear with high fever and swollen lymph nodes.

CAPS

• A few cases of systemic amyloidosis (a condition in which abnormal proteins accumulate in tissues and organs) have been reported in patients with NOMID/CINCA, who presented skin nodules at the injection sites (amyloid deposits) as the first manifestation. These patients had been using anakinra at high doses for several years. Symptoms of systemic amyloidosis may include swelling (especially in the legs and ankles), foamy urine, increased or decreased frequency of urination, muscle cramps, unexplained weight loss, diarrhea, or constipation, and fatigue. Inform your doctor if you notice any of these symptoms.

Children and adolescents

• RA: The use of Kineret in children and adolescents with rheumatoid arthritis (RA) has not been extensively investigated and therefore cannot be recommended.
• COVID‑19: The use of Kineret in children and adolescents with COVID‑19 has not been investigated and therefore cannot be recommended.
• CAPS, FMF, Still's disease: The use of Kineret is not recommended in children under 8months, as there are no data available for this age group.

Other medications and Kineret

Inform your doctor if you are using, have used recently, or may need to use any other medication.

Tumor necrosis factor (TNF‑α) inhibitors, such as etanercept, should not be used with Kineret, as this may increase the risk of infections.

When you start using Kineret, the chronic inflammation in your body will decrease. This may require adjusting the doses of other medications, such as warfarin or phenytoin.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, or think you may be pregnant, consult your doctor before using this medication.

Kineret has not been tested in pregnant women. It is not recommended to use Kineret during pregnancy or in women of childbearing age who do not use a contraceptive method. It is essential to inform your doctor if you are pregnant, think you may be pregnant, or intend to become pregnant. Your doctor will discuss with you the possible risks of taking Kineret during pregnancy.

The excretion of anakinra in breast milk is unknown. Stop breastfeeding if you are using Kineret.

Kineret contains sodium

This medication contains less than1mmol of sodium (23mg) per dose of100mg; this is essentially "sodium-free".

Follow exactly the administration instructions for this medication as indicated by your doctor. If in doubt, consult your doctor or pharmacist again. Kineret is injected under the skin (subcutaneous injection) daily. You should try to give yourself the injection at the same time every day.

The recommended dose is 20 to 90 mg or 100 mg. Your doctor will tell you the dose you need, or if you need a dose greater than 100 mg.

COVID-19: the recommended dose is 100 mg injected under the skin (subcutaneously) daily for 10 days.

Self-Administration of Kineret

Your doctor may decide that it is more convenient for you to inject Kineret yourself. Your doctor or nurse will teach you how to do it. Do not attempt to inject yourself if you have not been explained how to do it.

For information on how to inject Kineret yourself or inject it into your child, please read the section “Instructions for preparing and administering a Kineret injection” included at the end of this prospectus.

If You Use More Kineret Than You Should

You should not have any serious problems if, accidentally, you use more Kineret than you need. However, you should contact your doctor or pharmacist if this occurs. If you do not feel well, you should contact your doctor immediately.

If You Forget to Use Kineret

If you forget to give yourself a dose of Kineret, you should contact your doctor to discuss when you should give yourself the next dose.

Like all medicines, this medicine can cause side effects, although not everyone will experience them.

The possible side effects are similar whether Kineret is used for RA or CAPS, FMF, Still's disease, or COVID-19.-

If any of the following side effects occur, inform your doctor immediately:

• Severe infectionssuch as pneumonia (chest infection) or skin infections can occur during Kineret treatment. Symptoms may include persistent high fever, chills, cough, headache, and skin redness and pain. Other possible signs of infection are low-grade fever, weight loss, and persistent cough.
• Thesevere allergic reactionsare rare. However, some of the following symptoms may indicate a Kineret allergic reaction for which you should seek immediate medical attention. Do not inject more Kineret:

-Swelling of the face, tongue, or throat

-Difficulty swallowing or breathing

-Sudden sensation of rapid heartbeat or sweating

-Itching on the skin or rash

Very common side effects(may affect more than 1 in 10people):

• Redness, swelling, appearance of petechiae, or itching at the injection site. These symptoms are usually mild to moderate and more frequent at the beginning of treatment.
• Headache.
• Increased total cholesterol levels in the blood.

Common side effects(may affect up to 1 in 10people):

• Neutropenia (low white blood cell count) determined after a blood test. Neutropenia may increase the risk of infection. Symptoms of an infection may include fever or sore throat.
• Severe infections such as pneumonia (chest infection) or skin infections.
• Trombocytopenia (low platelet count in the blood).

Rare side effects(may affect up to 1 in 100people):

• Severe allergic reactions that include swelling of the face, tongue, or throat, difficulty swallowing or breathing, sudden sensation of rapid heartbeat or sweating, itching on the skin or rash.
• High levels of liver enzymes detected after a blood test.

Side effects of unknown frequency(cannot be estimated from available data):

• Signs of liver disorders, such as yellow skin and eyes, nausea, loss of appetite, dark urine, and pale stools.
• If Kineret is repeatedly injected in the same place, there is a risk of a lump (amyloid deposit) forming under the skin. Alternate the injection site to avoid it.

Reporting side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through thenational notification system included in theAppendixV. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

Keep this medication out of the sight and reach of children.

Do not use this medication after the expiration date that appears on the label and on the box after “CAD”. The expiration date is the last day of the month indicated.

Store in the refrigerator (between2°Cand8°C). Do not freeze.

Store in the original box to protect it from light.

Do not use Kineret if you believe it has been frozen. Once a syringe has been removed from the refrigerator and has reached room temperature (up to25°C), it must be used within the72hours following or discard. Do not store it back in the refrigerator if it has been stored at room temperature.

Medicines should not be disposed of through the drains or in the trash. Ask your pharmacist how to dispose of the containers and medications that you no longer need. This will help protect the environment.

Composition of Kineret

• The active ingredient is anakinra. Each pre-filled syringe contains 100 mg of anakinra.

• The other components (excipients) are: anhydrous citric acid, sodium chloride, disodium edetate dihydrate, polisorbate 80, sodium hydroxide, and water for injection.

Appearance of the product and contents of the pack

Kineret is a transparent, colourless to slightly white solution presented in a pre-filled syringe ready for use. The solution may contain protein particles with a translucent to white appearance, the presence of which does not affect the quality of the product.

Pack sizes of 1, 7 or 28 (multipack with 4 packs of 7 pre-filled syringes) pre-filled syringes.

Only some pack sizes may be marketed.

Holder of the marketing authorisation and responsible person for manufacture

Swedish Orphan Biovitrum AB (publ)

SE-112 76 Stockholm

Sweden

Last date of revision of the package leaflet: 11/2024

Further information is available on the website of the European Medicines Agency:http://www.ema.europa.eu.

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