Efficacy and safety of the interleukin-1 antagonist rilonacept in Schnitzler syndrome: an open-label study

Allergy. 2012 Jul;67(7):943-50. doi: 10.1111/j.1398-9995.2012.02843.x. Epub 2012 May 15.


Background: Schnitzler syndrome (SchS) is a rare disease with suspected autoinflammatory background that shares several clinical symptoms, including urticarial rash, fever episodes, arthralgia, and bone and muscle pain with cryopyrin-associated periodic syndromes (CAPS). Cryopyrin-associated periodic syndromes respond to treatment with interleukin-1 antagonists, and single case reports of Schnitzler syndrome have shown improvement following treatment with the interleukin-1 blocker anakinra. This study evaluated the effects of the interleukin-1 antagonist rilonacept on the clinical signs and symptoms of SchS.

Methods: Eight patients with SchS were included in this prospective, single-center, open-label study. After a 3-week baseline, patients received a subcutaneous loading dose of rilonacept 320 mg followed by weekly subcutaneous doses of 160 mg for up to 1 year. Efficacy was determined by patient-based daily health assessment forms, physician's global assessment (PGA), and measurement of inflammatory markers including C-reactive protein (CRP), serum amyloid A (SAA), and S100 calcium-binding protein A12 (S100A12).

Results: Treatment with rilonacept resulted in a rapid clinical response as demonstrated by significant reductions in daily health assessment scores and PGA scores compared with baseline levels (P < 0.05). These effects, which were accompanied by reductions in CRP and SAA, continued over the treatment duration. Rilonacept treatment was well tolerated. There were no treatment-related severe adverse events and no clinically significant changes in laboratory safety parameters.

Conclusion: Rilonacept was effective and well tolerated in patients with SchS and may represent a promising potential therapeutic option.

Trial registration: ClinicalTrials.gov NCT01045772.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Female
  • Humans
  • Inflammation Mediators / metabolism
  • Interleukin-1 / antagonists & inhibitors*
  • Male
  • Middle Aged
  • Recombinant Fusion Proteins / adverse effects
  • Recombinant Fusion Proteins / therapeutic use*
  • Schnitzler Syndrome / drug therapy*
  • Schnitzler Syndrome / metabolism
  • Schnitzler Syndrome / pathology
  • Treatment Outcome
  • Urticaria / drug therapy
  • Urticaria / pathology


  • Biomarkers
  • Inflammation Mediators
  • Interleukin-1
  • Recombinant Fusion Proteins
  • rilonacept

Associated data

  • ClinicalTrials.gov/NCT01045772