Review of indications and efficacy evaluation of canakinumab

Canakinumab (Canakinumab) is a humanized monoclonal antibody. Its mechanism of action is to selectively inhibit interleukin-1β (IL-1β), thereby regulating inflammation-mediated pathways. The drug, sold under the trade name ILARIS, is approved for a variety of rare autoinflammatory diseases and inflammation-driven rheumatic immune diseases.

Canakinumab was first used to treat Cryopyrin protein-associated periodic syndrome (CAPS), which is a monogenic autoinflammatory disease that covers familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS). It is mainly characterized by recurrent fever, joint pain, rash and fatigue. IL-1β plays a central role in the pathogenesis of CAPS. By continuously inhibiting this inflammatory factor, canakinumab can significantly relieve symptoms, reduce acute phase protein levels, and improve patients' quality of life. In multiple clinical studies, treated patients experienced improvements in efficacy indicators such as normal body temperature, reduced rash, and significant decreases in C-reactive protein and serum amyl A within days to weeks.

In addition, canakinumab is also approved for the treatment of tumor necrosis factor receptor-associated periodic syndrome (TRAPS), hyperimmunoglobulin D syndrome (HIDS)/mevalonate kinase deficiency (MKD), and familial Mediterranean fever (FMF). Common features of these diseases are recurrent episodes of inflammatory fever, abdominal pain, arthritis, cutaneous manifestations, and, in severe cases, concurrent amyloidosis. Conventional treatments such as colchicine or glucocorticoids are insufficiently effective or intolerable in some patients. Canakinumab provides an effective treatment. Clinical trials have proven that the drug can effectively reduce the frequency and duration of attacks and maintain inflammation in remission in most patients.

Canakinumab is also used to treat active Still's disease, including adult-onset Still's disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA). This disease is characterized by periodic hyperthermia, rheumatoid arthritis manifestations, and systemic inflammation, often with limited response to conventional antirheumatic drugs. In these patients, canakinumab can effectively alleviate fever, arthritis, hepatosplenomegaly and laboratory abnormalities, and is especially suitable for those who are dependent on glucocorticoids or have obvious adverse reactions. Studies have shown that after the application of canakinumab, most patients can achieve clinical remission and reduce their dependence on glucocorticoids.

In the treatment of gout attacks in adults, canakinumab is suitable for patients who cannot tolerate nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine and who are not suitable for repeated use of glucocorticoids. IL-1β is considered a key factor in the inflammatory cascade of gout attacks. By blocking this pathway, canakinumab can block the expansion of inflammation at the peak of pain. Clinical studies have shown that a single subcutaneous injection of canakinumab 150 mg can rapidly relieve symptoms and reduce the risk of subsequent attacks.

The safety of canakinumab has been extensively evaluated in different indications. Common adverse reactions include injection site reactions, upper respiratory tract infection and headache, most of which are mild to moderate. Due to its immune mechanism of inhibitingIL-1β, active infections, especially tuberculosis, should be ruled out before use. Long-term use requires regular monitoring of signs of infection and routine laboratory indicators to ensure treatment safety.

Overall, canakinumab plays a therapeutic role in a variety of autoinflammatory diseases mediated byIL-1β. Its stable efficacy and convenient administration provide an important targeted treatment option for clinical practice. During use, dose adjustment and risk assessment should be carried out strictly in accordance with the guidelines to maximize treatment benefits and reduce potential risks.

Reference materials:https://www.drugs.com/search.php?searchterm=ILARIS&sources%5B%5D=professional