Clinical Cases in Pharmacology Clinical Cases  ·  Infectious Disease III  ·  Internal Medicine and Non-Infectious Syndromes  ·  When Anakinra Isn't Enough
Infectious Disease III, Case 0015 — Internal Medicine and Non-Infectious Syndromes

When Anakinra Isn't Enough: Reaching Past IL-1

A young man's macrophage activation syndrome is worsening on maximal anakinra and steroids — the choice ahead is between a drug approved for exactly his diagnosis but resting on a very small evidence base, and the older, more toxic protocol with by far the longest track record.

Abbreviations, terms, and other agents mentioned in this case MAS — macrophage activation syndrome  ·  HLH-94 — the chemotherapy-based treatment protocol (etoposide plus dexamethasone) originally developed for hemophagocytic lymphohistiocytosis  ·  IFN-γ — interferon-gamma, the effector cytokine downstream of IL-18 now understood to drive much of MAS's pathophysiology
Presentation

Idris O., a 26-year-old graduate student in mechanical engineering, was diagnosed with adult-onset Still's disease four months ago and had been doing reasonably well on anakinra and a prednisone taper until ten days ago, when he developed recurrent high fevers, worsening cytopenias, and a ferritin that has climbed past 40,000 ng/mL despite his anakinra dose already being pushed to its upper labeled range. His fibrinogen has fallen below 100 mg/dL, his platelet count has dropped to 62,000/µL, and his transaminases have roughly tripled over the past four days — he now meets formal criteria for macrophage activation syndrome developing on top of his underlying AOSD, refractory to first-line IL-1 blockade and steroids.

Before this admission, Idris had no other significant medical history beyond the AOSD diagnosis itself four months ago, no prior hospitalizations, and had been back at his research lab full time for nearly six weeks, describing himself to his rheumatologist at his last outpatient visit as “finally feeling like a person again.” That recent, hard-won stability is part of what makes this admission land as more alarming to his care team than a first presentation of MAS might otherwise — not a new disease finding its footing, but a previously controlled one turning sharply worse.

What makes his particular case unusually informative for the choice ahead is a specific laboratory pattern, not just the severity of his decline: his free IL-18 level, sent once MAS was confirmed, has returned markedly elevated, disproportionately high relative to his ferritin compared to typical MAS laboratory profiles, pointing toward a disease genuinely dominated by the IL-18/interferon-gamma axis rather than a more generic hyperinflammatory picture. Two escalation strategies exist once IL-1 blockade fails, and they are not equivalent for a patient whose biology looks like his. The HLH-94 protocol, chemotherapy-based and the most established option across hemophagocytic syndromes broadly, carries substantial myelosuppression risk in a man already down to 62,000 platelets. Emapalumab, an anti-interferon-gamma monoclonal antibody, targets the effector his own labs implicate most directly — and since June 2025 it has carried a specific FDA approval for MAS in known or suspected Still's disease, adult-onset included, in patients with an inadequate response to glucocorticoids. That approval rests on the pooled EMERALD and NI-0501-06 trials, which required a ferritin above 684 ng/mL plus two of four laboratory findings to enroll; Idris clears the ferritin threshold roughly sixty-fold and meets three of the remaining four. He is critically ill but not yet in multiorgan failure, so there is time to weigh this — and what weighing it reveals is that the drug being treated here as the adventurous option is the one actually written for him.

Idris O. · 26 MAS complicating known AOSD
Underlying disease
AOSD, 4 months, prior response to anakinra/steroids
Ferritin
>40,000 ng/mL, still rising
Fibrinogen
<100 mg/dL
Platelets
62,000/µL, falling
Transaminases
~3x baseline, rising over 4 days
Free IL-18
Markedly elevated, disproportionate to ferritin
Current therapy
Anakinra at upper labeled dose, prednisone — disease refractory
Organ status
Critically ill, not yet in multiorgan failure

Combined rheumatology, hematology, and critical care consult

Hematologist/Oncologist Opening

Given how fast he's declining, I'd move to HLH-94 — etoposide and dexamethasone. I know emapalumab now carries the label for this exact indication. I also know that label rests on thirty-nine patients across two open-label single-arm trials with no control group, against decades of HLH-94 experience in severe refractory hemophagocytic disease of every etiology. An approval and a deep evidence base are not the same quantity, and I don't want to discover the difference while he's losing ground.

Rheumatologist Response

I'd point to emapalumab instead — it targets interferon-gamma, the specific downstream effector of the pathway his own labs are implicating most directly, and the trials behind its label enrolled adults and children with MAS in Still's disease who had failed high-dose glucocorticoids. That is a description of Idris, not a population I'm extrapolating toward. Fifty-four percent reached complete response by week eight. He's already down to 62,000 platelets; adding etoposide's myelosuppression on top of that is a real, immediate cost, not a distant one.

I'll grant you thirty-nine patients is thin. But HLH-94's depth is largely in primary HLH and malignancy-associated disease — it was never studied in Still's-associated MAS at all, so on his actual diagnosis your evidence base isn't deeper than mine, it's absent. Small-and-on-target still beats large-and-elsewhere.

Critical Care Physician Final

I think his own free IL-18 result is the thing that should actually decide this, not either of your general priors about the two protocols. It's disproportionately elevated relative to his ferritin in a way that's genuinely more specific to IL-18/interferon-gamma axis-driven disease than a typical MAS picture — that's evidence about him specifically, not just a mechanistic argument in the abstract.

Given that, I'd support emapalumab as the next step, and I'd note the trials permitted concomitant anakinra, so continuing his is consistent with how the drug was actually studied rather than an improvisation on top of it. But with an honest, named limit, not open-ended: if he isn't showing meaningful improvement in ferritin, fibrinogen, and clinical stability within 48 to 72 hours, we move to HLH-94 without further debate. That gives the more targeted approach a real chance given what his biology suggests, while keeping a concrete deadline so his overall decline doesn't get lost waiting on it.

Regimen selected
Emapalumab
Anti-Interferon-Gamma Monoclonal Antibody · Adopted, time-limited trial
FDA-approved since June 2025 for MAS in known or suspected Still's disease, adult-onset included, after inadequate response to glucocorticoids — an indication Idris meets squarely, and whose registration trials he would have qualified for on ferritin plus three of four laboratory criteria. Targets the IL-18/interferon-gamma axis his own disproportionate free IL-18 result implicates most directly, with a pre-agreed 48-72 hour window to demonstrate response.
Etoposide + Dexamethasone (HLH-94 protocol)
Cytotoxic Chemotherapy / Corticosteroid · Held, contingent
Not started today, but named explicitly as the pre-agreed next step if emapalumab hasn't produced meaningful improvement in ferritin, fibrinogen, and clinical stability within 48-72 hours.
Anakinra (continued)
IL-1 Receptor Antagonist · Continued
Maintained at current dose alongside the escalation decision — not discontinued, since stopping a partially effective agent while adding a new one would confound the response assessment, and the emapalumab registration trials themselves permitted concomitant anakinra.
Where this was left

Agreed: emapalumab started today, anakinra continued, with an explicit, pre-agreed 48-72 hour deadline for reassessing ferritin, fibrinogen, platelets, and clinical trajectory — the critical care physician's biology-specific framing gave the hematologist/oncologist's urgency and the rheumatologist's mechanistic preference a shared, checkable basis rather than requiring either to simply defer.

If meaningfully improved by 72 hours

Emapalumab continued, HLH-94 not pursued — treated as evidence the IL-18/interferon-gamma axis read was correct for his specific disease.

If not meaningfully improved by 72 hours

HLH-94 (etoposide/dexamethasone) started without further debate — the deadline agreed today is treated as binding, not renegotiated in the moment by whichever specialist is present then.

Educational content only — a composite teaching case, not a real patient encounter or a substitute for clinical guidance. About These Cases →