The use of Canakinumab, a novel IL-1β long-acting inhibitor, in refractory adult-onset Still's disease

Semin Arthritis Rheum. 2012 Oct;42(2):201-5. doi: 10.1016/j.semarthrit.2012.03.004. Epub 2012 Apr 17.


Objectives: We describe the successful treatment of adult-onset Still's disease (AOSD) with canakinumab, a novel anti-interleukin (IL)-1β, long-acting, monoclonal antibody, on patients refractory to anakinra and rilonacept. In many cases the expected positive therapeutic effect of short-acting IL-1 inhibitors is transient or completely absent, leading to our hypothesis that their short half-life may be associated with incomplete IL-1 blockade, given the cyclic nature of the disease.

Methods: We report 2 cases of AOSD resistant to short-acting IL-1 blockade, which were subsequently treated with canakinumab. A retrospective chart review was conducted of patients diagnosed with AOSD in our regional referral center.

Results: Response to treatment was assessed by its effect on the systemic symptoms (resolution of fever and rash), polyarthritis (using the disease activity score 28--C-reactive protein score), and the levels of serum ferritin. Canakinumab demonstrated sustained efficacy in both patients as evidenced by clinical and laboratory parameters with minimal adverse reactions.

Conclusions: This is the first documented report of successful use of canakinumab, a novel IL-1β inhibitor, in AOSD patients refractory to traditional disease-modifying antirheumatic drugs and short- to moderate-acting IL-1 blockade. Prospective comparative studies are needed to validate canakinumab's efficacy and safety.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents / pharmacology
  • Antirheumatic Agents / therapeutic use*
  • Drug Resistance / drug effects
  • Female
  • Health Status
  • Humans
  • Interleukin-1beta / antagonists & inhibitors*
  • Male
  • Retrospective Studies
  • Still's Disease, Adult-Onset / drug therapy*
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Interleukin-1beta
  • canakinumab