Club Rhumatismes et Inflammation guidelines for anti-interleukin-1 therapy: 2026 update

Interleukin-1 inhibitors (anti-IL-1 agents) are an essential therapeutic class in the management of autoinflammatory diseases (AIDs). The latest version of the Club Rhumatismes et Inflammations (CRI) guidelines for anti-IL-1 therapy dates from 2014. The present work aimed to update the CRI guidelines.

A group of 13 writers (6 rheumatologists, 3 internists, and 4 paediatricians) who are experts in AIDs conducted a rigorous review of the literature up to November 2025 in their respective fields of expertise to write each guideline area. All guidelines were reviewed by the two scientific coordinators.

The update concerned only the two anti-IL-1 molecules available in France and most European countries: anakinra and canakinumab. A total of 20 sets of guidelines were written on pre-treatment assessment and follow-up of patients on anti-IL-1 therapy as well as the course of action to be taken in the event of bacterial or viral infections, solid or haematological neoplasia, haematologic biological abnormalities, cardiovascular conditions, skin or systemic intolerance, autoimmune or demyelinating conditions, biological hepatitis, macrophage activation syndrome, renal failure or dialysis, drug combinations, surgery, dental care, burns or trauma, pregnancy, use of anti-IL-1 agents in low-weight children, vaccination, travel, Kawasaki disease, recurrent pericarditis, acute gout attacks and Schnitzler syndrome.

These guidelines are a practical tool for clinicians, summarizing the course of action to be taken in clinical situations they may encounter, based on the latest scientific data on efficacy and tolerance.