What is the role of rilonacept and canakinumab in the treatment of familial Mediterranean fever (FMF)?

Updated: Apr 07, 2020
  • Author: John O Meyerhoff, MD; Chief Editor: Herbert S Diamond, MD  more...
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Rilonacept, given by once-weekly subcutaneous injection, has been shown, in combination with continuation of colchicine, to reduce the number of attacks in patients who did not respond optimally. [27] Interferon-alpha has been used in an intermittent fashion and as prophylaxis, with varying results. [28, 29, 30]

A systematic review found that in patients who do not respond to colchicine or cannot tolerate it, anti–IL-1 treatment resulted in a complete response to therapy, without a single attack during treatment, in 76.5% of patients treated with anakinra and 67.5% of those treated with canakinumab. In addition, anti–IL-1 treatment proved able to reverse proteinuria in patients with established type AA amyloidosis. [31]

Canakinumab was approved by the US Food and Drug Administration for FMF in September 2016. Canakinumab is a human monoclonal anti-human IL-1β antibody of the IgG1/kappa isotype. It binds to human IL­1β and neutralizes its activity by blocking its interaction with IL-1 receptors. Approval was based on the phase 3 CLUSTER study, which showed disease control beginning at day 15 and lasting through 16 weeks when compared with placebo. [32]

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