Canakinumab for the treatment of active systemic juvenile idiopathic arthritis

Introduction: Canakinumab, a fully human monoclonal antibody against interleukin-1β, is a relatively new medication approved for treatment of systemic juvenile idiopathic arthritis (SJIA). Here, we review data supporting use of canakinumab for patients with active SJIA, as compared to other available biologic medications. Areas covered: This article provides an overview of chemistry of canakinumab as well as the phase II and phase III trials that led to approval for treatment of active SJIA. To undertake this review, the authors performed literature search using Pubmed, with keywords ‘canakinumab,’ ‘biologic,’ ‘anti-IL-1B,’ and ‘systemic juvenile idiopathic arthritis,’ focusing on publications within the last 5 years. Expert commentary: Canakinumab has shown efficacy in treatment of SJIA with active systemic features including fever. There is no evidence to suggest increased risk of macrophage activation syndrome. Its use in the treatment of chronic arthritis without active systemic features has not been approved and warrants further study.