Last updated: October 29, 2014
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
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
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.
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.