Canakinumab for the treatment of systemic juvenile idiopathic arthritis

The introduction of methotrexate in the 1980s and of TNF-inhibiting agents and abatacept in the late 1990s led to a dramatic improvement in the outcomes of non-systemic categories of juvenile idiopathic arthritis. By contrast, the same treatment approaches had no strong impact on the outcome of systemic juvenile idiopathic arthritis (SJIA), and the main effective treatment in these patients remained glucocorticoids with their known side effects. Encouraging findings in small studies involving SJIA patients treated with IL-1 and IL-6 inhibitors led to large Phase III trials, and the results in these trials provide hope that substantial joint damage and disability seen in the majority of patients with persistent SJIA can be prevented. The purpose of this review is to discuss the safety and efficacy of the IL-1 and IL-6 inhibiting agents in SJIA with the main focus on canakinumab, a fully human monoclonal anti-IL-1β antibody.