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Comparative Efficacy and Safety of Anakinra and Canakinumab in Patients With VEXAS Syndrome: An International

Tali Eviatar1,2, Dafne Capelusnik1,2,3, Corrado Campochiaro4

  • 1Rheumatology Department, Tel Aviv Medical Center, Tel Aviv, Israel.

Arthritis & Rheumatology (Hoboken, N.J.)
|September 22, 2025
PubMed
Abstract

Insights

Canakinumab showed better clinical response and drug survival with fewer side effects than anakinra for VEXAS syndrome. Monthly canakinumab 300 mg is a potential steroid-sparing treatment option for VEXAS patients.

Area of Science:

  • Rheumatology
  • Immunology
  • Genetics

Background:

  • VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a rare autoinflammatory disease.
  • Interleukin-1 (IL-1) inhibitors are used to manage VEXAS syndrome.
  • Limited comparative data exists for anakinra and canakinumab in VEXAS patients.

Purpose of the Study:

  • To compare the clinical response, drug survival, and adverse event rates of anakinra and canakinumab in patients with VEXAS syndrome.
  • To identify factors associated with treatment outcomes in VEXAS syndrome.

Main Methods:

  • Multicenter international study of VEXAS patients treated with IL-1 inhibitors.
  • Global response (GR) defined as absence of inflammatory symptoms and significant reduction in steroid dose and C-reactive protein.
  • Statistical analyses included multiple regression, Kaplan-Meier plots, log-rank test, and Cox regression models.

Main Results:

  • Canakinumab demonstrated significantly higher GR rates at 1 month (100% vs 34%) and 3 months (78% vs 22%) compared to anakinra.
  • Canakinumab treatment was associated with a higher odds ratio for achieving GR at 3 months (OR 28.8).
  • Median drug survival was longer for canakinumab (54 months at 300 mg/month) than anakinra (1 month). Injection-site reactions and infections were more frequent with anakinra.

Conclusions:

  • Canakinumab is superior to anakinra in terms of clinical response and drug survival for VEXAS syndrome.
  • Canakinumab 300 mg monthly offers an effective, steroid-sparing treatment option for VEXAS patients.
  • Further research may explore optimal dosing and long-term outcomes.

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