Canakinumab

Canakinumab
Mass / length primary structure	1322-1324 amino acids , 145,157 Da
Identifier
External IDs	CAS number : 914613-48-2;
Drug information
ATC code	L04 AC08
DrugBank	DB06168

Canakinumab (trade name Ilaris ; manufacturer Novartis ; ATC code L04 AC08 ) is a humanized, monoclonal antibody against interleukin-1β (IL-1β) for the treatment of (systemic) juvenile idiopathic arthritis (sJIA) (Still's disease) and both diseases of cryopyrin-Associated Periodic syndromes (CAPS), Familial Cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome . Interleukin-1β is a cytokine that regulates inflammatory reactions in the human body. In addition, this cytokine is mainly produced by blood monocytes .

Application form and dosage

Canakinumab is given as a subcutaneous injection. The dosage of canakinumab is very diverse due to the variety of diseases that can be treated with it. Usually the dosage is 2 mg / kg and 4 mg / kg and the maximum dose is 300 mg, Still's disease or 600 mg, periodic fever syndromes . One solution for injection contains 150 mg canakinumab.

Clinical information

Systemic juvenile idiopathic arthritis (sJIA)

Canakinumab is approved for children with systemic juvenile idiopathic arthritis (sJIA) from the age of 2 and therefore also for adult breastfeeding. For sJIA there are two suggested therapy options by the manufacturer:

A monotherapy
A combination therapy with methotrexate

Canakinumab blocks the interleukin-1β receptor. In this way, the underlying disease is combated and corresponding blood values such as the CRP value drop back into the normal range. The manufacturer, Novartis, recommends a dose of 4 mg / kg for a body weight of 7.5 kg or more. This should take place every four weeks in the form of a subcutaneous injection by a doctor. The maximum dose here is 300 mg. If there is no improvement, further canakinumab treatment should be avoided.

Periodic fever syndromes

In addition to rheumatic diseases, canakinumab is also a treatment option for the following periodic fever syndromes :

Cryopyrin-Associated Periodic Syndromes

For cryopyrin-associated periodic syndrome (CAPS), canakinumab is approved from the age of 2. Here, 150 mg or 2 mg / kg, depending on body weight, are applied as an initial dose. If there is no progress after seven days, a second injection at the same dose should be considered.

If this is successful, a next injection of 300 mg or 4 mg / kg should be given every eight weeks.

TRAPS, MKD / HIDS, FMF

Canakinumab is also approved for tumor necrosis factor receptor-associated periodic syndrome (TRAPS) , hyperimmunoglobulin D syndrome (HIDS), mevalonate kinase deficiency (MKD) and familial Mediterranean fever (FMF). Here, too, Novartis recommends different starting doses:

If the patient weighs more than 40 kg, the recommended starting dose is 150 mg.
If the patient weighs between 7.5 kg and 40 kg, the manufacturer recommends 2 mg / kg.

As with the sJIA, a single subcutaneous injection is given every four weeks.

Gouty arthritis

In gouty arthritis , canakinumab is used for the symptomatic treatment of adult patients with frequent attacks of gout (at least three in the last 12 months). Canakinumab is only administered here, however, if nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine are contraindicated or incompatible. Canakinumab can also be used in a severe attack of gout if there is no improvement after repeated cortisone cycles.

Side effects

Canakinumab is usually well tolerated. Possible side effects are:

Redness at the injection site
itching
dizziness
Upper respiratory tract infection

Interactions

So far (as of 2017) no interactions with other drugs have been found. However, canakinumab should not be used in combination with other biologics .

pregnancy and breast feeding period

The availability of data from pregnant canakinumab patients is very limited. Here, the manufacturer suggests a thorough risk-benefit assessment by the attending physician. Nevertheless, it is recommended that newborns be given live vaccines 16 weeks after birth .

Individual evidence

↑ Ilaris. Novartis Pharmaceutical, December 2016, accessed February 3, 2020 .
↑ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Novartis Pharma: Ilaris - Product information 150 mg / ml solution for injection. In: Ilaris ^® (canakinumab) - information on safe use . Novartis Pharma, July 1, 2019, accessed February 3, 2020 .
↑ ^a ^b Treatment with canakinumab. German Society for Rheumatology ev, June 1, 2017, accessed on February 9, 2020 .

[1] Ilaris. Novartis Pharmaceutical, December 2016, accessed February 3, 2020 .

[:0-2] ↑ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Novartis Pharma: Ilaris - Product information 150 mg / ml solution for injection. In: Ilaris ^® (canakinumab) - information on safe use . Novartis Pharma, July 1, 2019, accessed February 3, 2020 .

[:1-3] Treatment with canakinumab. German Society for Rheumatology ev, June 1, 2017, accessed on February 9, 2020 .