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What is Canakinumab?
Canakinumab is an exceptional drug belonging to the family of biotherapies targeting interleukin 1 (IL-1), one of the molecules responsible for the symptoms of inflammation in autoinflammatory diseases. It is a monoclonal antibody directed against IL-1, which blocks its effect in the body and suppresses the symptoms of inflammation. It has been used in autoinflammatory diseases since 2009.
Indication and dosage
Canakinumab is a 2nd line drug indicated for :
Cryopyrinopathies.
Familial Mediterranean fever in cases of resistance, intolerance or contraindication to colchicine.
Mevalonate kinase deficiency.
TRAPS syndrome.
Gout arthritis.
It is prescribed by your specialist doctor on an exceptional prescription. Once collected from the pharmacy, it should be kept refrigerated at 4°C. When travelling, it must be carried in a small cool box to keep it at 4°C.
It is administered by subcutaneous injection at a fixed dose of 150 mg. The interval between injections varies from patient to patient: generally every 8 weeks, but it can be shorter.
Injections can be given by the patient themselves, or with the help of a nurse at home.
Before prescribing Canakinumab ®
Before starting Canakinumab, your specialist doctor will carry out a check-up to rule out any contraindications to treatment, such as infection (particularly dental or pulmonary).
It is necessary to update your compulsory vaccinations with your GP and to be vaccinated against influenza and pneumococcus.
Advice on administering
- Take canakinumab out of the fridge 15 to 30 minutes before the injection so that it is at room temperature.
- You can place an ice pack in a cloth on the skin for 15 minutes before the injection to anaesthetise the skin and 15 minutes after the injection.
- Carefully disinfect the skin around the injection site.
- Inject subcutaneously: lower abdomen, thigh, arm.
Tolerance
Canakinumab requires monthly biological monitoring, initially to check its efficacy (normalisation of CRP) and safety (haemogram, transaminases), then at intervals before each new injection.
Canakinumab almost never causes reactions at the injection site, and the injection is not painful.
One side-effect is the more frequent occurrence of upper respiratory tract infections (rhinopharyngitis, bronchitis).
Practical questions
If an infection occurs and fever persists for more than 48 hours, you should consult your GP as soon as possible to assess the situation.
It is not necessary to stop taking Canakinumab in the event of scaling. In the event of dental extraction or abscess, it is recommended that Canakinumab be discontinued one week before the procedure and that antibiotic prophylaxis be offered in conjunction with the procedure. In the event of more extensive surgery, your dentist should discuss with your specialist whether you should temporarily stop taking Canakinumab.
In the event of surgery, your surgeon should discuss with your specialist whether you should temporarily stop taking Canakinumab.
Vaccination under Canakinumab
The only vaccines contraindicated when taking Canakinumab are live attenuated vaccines (BCG, measles, mumps, rubella (MMR), chickenpox, yellow fever, oral polio). If you need these vaccinations to travel to tropical countries, you should inform your specialist doctor so that Canakinumab can be temporarily suspended.
Annual influenza vaccination is strongly recommended.
Fertility, pregnancy & breastfeeding
Limited data are available on the use of Canakinumab in pregnant women.
No effect of Canakinumab on fertility, early development, embryo-foetal development or peri- and post-natal development has been observed in pregnant marmoset monkeys at doses higher than those used in the human clinic. As a result, we sometimes prescribe Canakinumab for certain autoinflammatory diseases, including during pregnancy, after carefully explaining the benefits and risks to the patient.
The excretion of Canakinumab and its metabolites into breast milk is unknown.
However, monitoring data from the Teratogen Reference Centre (CRAT) are reassuring and its use during breast-feeding may be envisaged in agreement with the referring physician and paediatrician.