Canakinumab in pediatric rheumatic diseases

Introduction: Hitherto, some of the most severe forms of arthritis with onset in the neonatal period and early childhood have been resistant to conventional and anti-tumour necrosis factor agents. Recent results from drug trials of novel monoclonal antibodies will significantly alter the treatment of two of these diseases. This review is for canakinumab, a new monoclonal antibody to interleukin 1 beta that has been shown to be specifically efficacious in two groups of arthritis with systemic features. Areas covered: The clinical features and treatment to-date in the autoinflammatory disease, cryopyrin associated periodic fever syndrome and systemic juvenile idiopathic arthritis are briefly reviewed. An overview of current IL-1 inhibitors is provided. Clinical trials of Canakinumab in the treatment of these two diseases are evaluated. Expert opinion: The last decade has seen a major advance in treatment leading to remission while on therapy for many children with CAPS and sJIA. The outcomes of the anti-IL-1 beta and the anti-IL-6 trials for sJIA are quite similar and do not enable preferential use of either biological in a given patient.