Canakinumab, sold under the brand name Ilaris, is a medication for the treatment of systemic juvenile idiopathic arthritis, active Still's disease, including adult-onset Still's disease, gout flares. It is a human monoclonal antibody targeted at interleukin-1β. It has no cross-reactivity with other members of the interleukin-1 family, including interleukin-1 alpha.
Common side effects include infections (colds and upper respiratory tract infections), abdominal pain and injection-site reactions.
Medical uses Canakinumab is approved for the treatment of cryopyrin-associated periodic syndromes (CAPS) in the US and Europe Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged. and for gout in the US. CAPS is a spectrum of autoinflammatory syndromes including Familial Cold Autoinflammatory Syndrome (FCAS), Muckle–Wells syndrome (MWS), and Neonatal-Onset Multisystem Inflammatory Disease (NOMID).
In September 2016, the FDA approved the use of canakinumab for three additional rare and serious auto-inflammatory diseases: tumor necrosis factor receptor associated periodic syndrome (TRAPS), hyperimmunoglobulin D syndrome (HIDS)/mevalonate kinase deficiency (MKD), and familial mediterranean fever (FMF).
In June 2020, canakinumab was approved in the United States for the indication to treat active Still's disease, including adult-onset Still's disease.
In the European Union, canakinumab is indicated for autoinflammatory periodic fever syndromes, cryopyrin-associated periodic syndromes (CAPS), tumour necrosis factor receptor associated periodic syndrome (TRAPS), hyperimmunoglobulin D syndrome (HIDS)/mevalonate kinase deficiency (MKD), familial Mediterranean fever (FMF), Still's disease, and gouty arthritis.
In August 2023, the FDA expanded coverage to cover the treatment of gout flares.
Adverse effects Injection site reactions such as redness and pain are common, occurring in approximately 15.5% of cases. The FDA prescribing information includes a warning for potential increased risk of serious infections due to IL-1 blockade. Macrophage activation syndrome (MAS) is a known, life-threatening disorder that may develop in people with rheumatic conditions, in particular Still's disease, and should be aggressively treated. Treatment with immunosuppressants may increase the risk of malignancies. People are advised not to receive live vaccinations during treatment.
History Canakinumab was being developed by Novartis for the treatment of rheumatoid arthritis, but this trial was completed in October 2009. Canakinumab is also in phase I clinical trials as a possible treatment for chronic obstructive pulmonary disease, gout, and coronary artery disease (the CANTOS trial). It is also in trials for schizophrenia. In gout, it may result in better outcomes than a low dose of a steroid, but costs five thousand times more.
The U.S. Food and Drug Administration (FDA) approved canakinumab for CAPS in June 2009, followed by the European Medicines Agency (EMA) in October.
In August 2017, the results of the CANTOS trial were announced at the European Society of Cardiology. Those treated in CANTOS had a 15% reduction in deaths from heart attacks, stroke and cardiovascular disease combined. However, CANTOS reported serious side-effects and no statistically significant overall survival benefit.
Nonetheless, David Goff, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute claimed the "public health impact potential is really substantial", and estimated that in the United States 3 million people might benefit from the drug.
Further analysis on data from CANTOS showed a significant (1/3-2/3) reduction in lung cancer incidence and mortality in the treatment group.
In August 2023, the FDA approved canakinumab for the symptomatic treatment of adults with gout flares in whom nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine are contraindicated, are not tolerated, or do not provide an adequate response, and in whom repeated courses of corticosteroids are not appropriate, based on three studies.
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