Drug2nd line5 diseases
Canakinumab
Anti-IL-1beta monoclonal antibody
- Response rate
- ~67%
- Onset
- Days to weeks
- Route
- SC 150-300 mg every 4 weeks
- Line
- 2nd
- IgM effect
- Rapid ferritin reduction
- Evidence level
- green
Used across diseases
| Disease | Response rate | Line | Evidence |
|---|---|---|---|
| Adult-Onset Still's Disease | ~67% | 2nd | green |
| Cryopyrin-Associated Periodic Syndromes | 78-97% complete response | 1st | green |
| Familial Mediterranean Fever | 67.5% complete response | 2nd | green |
| Schnitzler Syndrome | High (RCT confirmed) | 2nd | amber |
| TNF Receptor-Associated Periodic Syndrome | 45% complete (Phase III); >94% disease control (long-term) | 1st | green |
Evidence summary
Long-acting anti-IL-1beta monoclonal antibody. The CONSIDER phase II RCT showed 67% response (vs 41% placebo). Received EMA conditional marketing authorization for Still's disease (including AOSD) in 2020. FDA approved canakinumab for sJIA in 2013 but has not granted a separate AOSD indication. Advantage over anakinra is less frequent dosing (monthly vs daily). Effective for both systemic and articular manifestations.
Molecular targets
| Molecule | Role | Expression | Evidence |
|---|---|---|---|
| IL-1β | Central pro-inflammatory cytokine driving systemic inflammation | Elevated | established |