Anakinra for Palmoplantar Pustulosis: Four Checks

Fungal infection can resemble palmoplantar pustulosis, according to the British Association of Dermatologists¹. Assessment may include a skin scraping, swab or biopsy.¹

Trial population

APRICOT treated 64 eligible adults with moderate-to-severe palmoplantar pustulosis: 100 mg anakinra injected daily for eight weeks, or placebo. Disease had lasted over six months despite topical treatment.²

Primary result

A planned first stage selected PPPASI, a clinician’s area/severity score for palms and soles (lower is better). The baseline-adjusted week-eight difference was −1.65 points (95% confidence interval −4.77 to 1.47; P = .30). This did not establish superiority or equivalence.²

Analysis included 63 people; 60 had week-eight scores. Modeling assumed missingness was explained by observed data.²

Injections

48% taking anakinra took ≥90% of planned injections. Injection-site reactions affected 19/31 versus 1/33, anakinra versus placebo. Eight weeks cannot establish long-term safety.²

MRC/NIHR³ funded it; Sobi supplied injections. Disclosures included Sobi research-nurse funding.²³

Prescribing checks

The current US Kineret label lists rheumatoid arthritis and two rare inflammatory conditions, NOMID and DIRA, not palmoplantar pustulosis. Using it for this skin condition is off-label. It says not to start treatment with an active infection and advises assessment for possible latent tuberculosis before treatment.⁴

It requires neutrophil counts before treatment, monthly for three months, then quarterly for up to one year. Live vaccines should not be given concurrently; combining it with TNF blockers such as etanercept is not recommended. Severe kidney impairment can require a less frequent dosing schedule. Bring your medicines and vaccination record to the review.⁴

The dermatology leaflet describes treatment tailored to disease severity, ranging from topical treatments to specialist light treatment or systemic medicines. It does not establish anakinra as a preferred option. Ask what the next plan aims to change: painful cracks, pustules, walking or using your hands.¹

The Describe It Before You Sort It section in Skin, Head to Toe asks for the location, appearance and sensation, speed of change and other body changes. Add photographs and dates if available. That description belongs at the assessment; it cannot identify a diagnosis by itself.