Canakinumab
Interleukin inhibitors
Interleukin inhibitors
A human antibody against interleukin-1β, injected under the skin, for periodic fever syndromes, Still's disease and hard-to-treat gout flares.
Quick facts
- Group
- Interleukin inhibitors
- Target
- Interleukin-1β (IL-1β)
- Used for
- Cryopyrin-associated periodic syndromes
- Key effects
- Injection-site pain · Nausea · Stuffy nose
- Monitor
- Latent tuberculosis test before starting
- ATC
- L04AC08
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows human IL-1β bound to the Fab fragment of canakinumab (the antibody's antigen-binding arm).
Canakinumab is a human IgG1 monoclonal antibody that binds interleukin-1β and keeps it from activating the IL-1 receptor. IL-1β drives the fever, rash, joint pain and acute-phase response of autoinflammatory diseases, so these flares settle when it is neutralised.
- Antibody binds circulating interleukin-1β
- IL-1β can no longer activate the IL-1 receptor
- Less fever and acute-phase response
- Autoinflammatory and gout flares settle
Indications
- Cryopyrin-associated periodic syndromes (familial cold autoinflammatory syndrome, Muckle-Wells syndrome)
- TRAPS and mevalonate kinase deficiency (hyper-IgD syndrome)
- Familial Mediterranean fever Familial Mediterranean fever and other hereditary autoinflammatory syndromes →
- Adult-onset Still's disease Adult-onset Still disease →
- Systemic juvenile idiopathic arthritis Juvenile idiopathic arthritis →
- Gout flares when other treatments failed or cannot be used Gout →
Adverse effects
Common
- Injection-site pain, redness, swelling or itching
- Nausea, vomiting, diarrhoea or abdominal pain
- Stuffy nose, headache, dizziness
- Back, muscle or joint pain
Contraindications
- Hypersensitivity to canakinumab
- Active serious infection
Key interactions
- Other medicines that suppress the immune system
- Added immunosuppression and infection risk.
- Vaccines, especially live vaccines
- Avoided during treatment unless the team agrees; age-appropriate vaccines are given before starting.
What is monitored
- Latent tuberculosis test before starting
- Signs of infection at every visit
- New or worsening fever, rash or malaise in Still's disease (macrophage activation syndrome)
- Laboratory tests ordered by the team
Administration and safety
- Injected under the skin by a doctor or nurse.
- Age-appropriate vaccines are completed before the first dose, where possible.
- The dose is not given during an active infection without the team's review.
Pregnancy and breastfeeding
Human data are limited. Exposure in pregnancy may weaken the baby's response to vaccines, so the baby's doctor is told.
Nursing care
- Confirm the latent tuberculosis test and vaccine status before the first dose.
- Check for fever, sore throat, cough or painful skin before each injection.
- Teach to report new or worsening symptoms quickly in Still's disease: macrophage activation syndrome can be life-threatening.
- If the drug was given in pregnancy, remind the family to tell the baby's doctor before infant vaccines.
Pharmacokinetics
- Absorption
- Subcutaneous injection given by a doctor or nurse
- Metabolism
- Broken down like other antibodies
Test yourself
Think of the answer, then tap the question to see it.
What does canakinumab bind?
Interleukin-1β itself (anakinra, by contrast, blocks the IL-1 receptor).
Which life-threatening complication is watched for in Still's disease treated with canakinumab?
Macrophage activation syndrome.
Which infection screening test is done before starting canakinumab?
A test for latent tuberculosis.
Connections
← Back to the class: Interleukin inhibitors
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Canakinumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2023); RCSB PDB - 4G6J: Crystal structure of human IL-1beta in complex with the therapeutic antibody binding fragment of canakinumab (RCSB Protein Data Bank, 2012); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.