Expedited Desensitization to Canakinumab

Area of Science:

• Immunology
• Rheumatology
• Pharmacology

Background:

• Interleukin-1 (IL-1) antagonists are established treatments for monogenic autoinflammatory diseases like Familial Mediterranean Fever (FMF).
• Anakinra, an IL-1 receptor antagonist, effectively manages persistent autoinflammation but can cause anaphylaxis.
• Canakinumab is an anti-IL-1β monoclonal antibody used for autoinflammatory conditions.

Observation:

• A 51-year-old male with FMF experienced treatment failure with colchicine, NSAIDs, and anakinra.
• Anakinra desensitization and canakinumab intradermal testing (IDT) induced anaphylactic and allergic symptoms, respectively.
• The patient presented with gastrointestinal intolerance to colchicine and continued FMF flares.

Findings:

• An expedited desensitization protocol for canakinumab was successfully implemented.
• The protocol involved 13 doses with 15-minute intervals, increasing to 150 mg.
• This novel approach demonstrated efficacy in a patient with hypersensitivity to biologics.

Implications:

• Hypersensitivity reactions, including anaphylaxis, can occur with biologic agents.
• Expanding use of biologics may increase the incidence of IgE-mediated hypersensitivities.
• Expedited desensitization protocols, like the one developed here, are crucial for managing patients intolerant to biologic therapies.