CanakinumabRx

Trade Names: Ilaris

Drug Class: IL-1 antagonist

Preparations: 180 mg vial

Dose: CAPS: children older than 4 years: 15-40 kg 2 mg/kg every 8 weeks, more than 40 kg: 150 mg every 8 weeks; adults >40 kg: 150 mg every 8 weeks by subcutaneous injection
Systemic juvenile idiopathic arthritis in patients more than 7.5 kg: 4 mg/kg every 4 weeks (maximum 300 mg/dose) by subcutaneous injection

Indications: Cryopyrin-associated periodic syndrome (CAPS), systemic juvenile idiopathic arthritis (Still’s disease)

Mechanism of Action: Binds to IL-1 beta preventing interaction with receptors thus blocking the effects of the cytokine

Contraindications: Hypersensitivity, active or chronic infection,

Precautions: Discontinue if patient develops an infection. Avoid live vaccines. Macrophage activation syndrome may develop – relation to drug unclear. Exclude TB and monitor for new infection. Concurrent use of other immunosuppressants may increase risk of infection; do not use with other IL-1 antagonists, TNF-antagonists, biologics, tofacitinib, abatacept.

Monitoring: Monitor clinically for infection; CBC after 1-2 months, then periodically

Pregnancy Risk: C

Adverse Effects
Common: Injection site reactions, headache, vertigo, diarrhea, nasopharyngitis, abdominal pain, weight gain
Less common: Infection including opportunistic infections, antibody formation, leucopenia, increased liver function tests
Rare: Hypersensitivity, neutropenia

Drug Interactions:
Other immunosuppressants: increased risk of infection

Patient Instructions: Avoid live virus vaccines. Avoid pregnancy. Stop if an infection or a fever develops that lasts more than a few days.

Comments: In clinical studies was effective for the treatment of acute attacks of gout in patients refractory to, or with contraindications to, NSAIDs and colchicine.

Clinical Pharmacology: Half-life is 26 days. Biologic agents are not metabolized and have few drug interactions.

Cost: $$$$$

BIBLIOGRAPHY

Ruperto N, Brunner HI, Quartier P, et al. Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis. N Engl J Med 2012;367:2396-406.PMID: 23252526.

Schlesinger N, Alten RE, Bardin T, et al. Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions. Ann Rheum Dis 2012;711839-48. PMID: 22586173.