Canakinumab: a review of its use in the management of systemic juvenile idiopathic arthritis.

Subcutaneous canakinumab (Ilaris(®)) is a human monoclonal anti-human interleukin (IL)-1β antibody of the immunoglobulin G1/κ isotype that binds with high affinity and specificity to human IL-1β, blocking its interaction with IL-1 receptors. It is approved in the EU as monotherapy or in combination with methotrexate for the treatment of patients aged ≥2 years with active systemic juvenile idiopathic arthritis (SJIA) who have responded inadequately to previous therapy with non-steroidal anti-inflammatory drugs and systemic corticosteroids. In the USA, it is indicated for the treatment of patients aged ≥2 years with active SJIA. In two placebo-controlled, multinational, phase III studies in patients aged 2-19 years with SJIA, canakinumab rapidly reduced disease activity, permitted the tapering of glucocorticoid therapy and delayed the time to disease flare. The efficacy of canakinumab was sustained at a median follow-up of 49 weeks in an ongoing extension study. In clinical studies, canakinumab had an acceptable tolerability profile that was comparable with that observed in patients with cryopyrin-associated periodic syndromes. In general, adverse events were mild or moderate in intensity, with nasopharyngitis, cough, pyrexia, vomiting, diarrhoea and upper respiratory tract infection the most frequently reported treatment-emergent adverse events. Thus, current evidence suggests subcutaneous canakinumab extends the treatment options currently available for patients aged ≥2 years with SJIA.