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How are IL 1 inhibitors supplied and used? What are their indications and toxicities?
• Anakinra (Kineret). Available formulation: single-use vial of 100 mg. Dosage: adults 100 mg SC daily; children 1 to 2 mg/kg (up to 8 mg/kg) daily. Follow-up: CBC monthly for 3 months, then every 3 months. Adverse reactions: serious infections (2%), neutropenia (3%). Injection site reactions (70%): less likely if ice is placed on skin before injection. Treat with topical steroids. Precautions: do not use in patients with active infection. Do not combine with other biologics. FDA-approved indication: RA, neonatal-onset multisystem inflammatory disease. • Rilonacept (Arcalyst). Available formulation: single-use, glass vial containing 220 mg of lyophilized powder for reconstitution. Pediatric dose. Ages 12 to 17 dose: load with one dose 4.4 mg/kg (maximum 320 mg) followed by 2.2 mg/kg (maximum 160 mg) SC weekly. Adult dose: load with one dose 320 mg followed by 160 mg SC weekly. Follow-up: CBC periodically. Get lipid profile at 3 months. Adverse reactions: injection site reaction (48%), infections (25%), serious infections (rare), other common symptoms. Precautions: do not use in patients with active infection; warfarin interaction. FDA-approved indication: CAPS (familial cold autoinflammatory syndrome [FCAS], Muckle–Wells syndrome [MWS]). • Canakinumab (Ilaris). Available formulation: glass vial containing 150 mg of lyophilized powder for reconstitution; 150 mg/mL solution in single-dose vials. Adult and pediatric dose: Patient weight ≥40 kg: 150 mg SC (max 300 mg) every 8 weeks. Patient weight 7.5 to 40 kg: 2 mg/kg (max 4 mg/kg) every 8 weeks. Follow-up: CBC and hepatic enzymes periodically. Adverse reactions: nasopharyngitis, diarrhea, vertigo (10%), headache, injection site reactions (9%), other common symptoms. Precautions: do not use in patients with active infection; warfarin interaction. FDA-approved indication: CAPS (FCAS, MWS), systemic JIA (Still’s disease). • Other diseases IL-1 inhibitors used in with success: gout, pseudogout, Behćet’s, PAPA syndrome, Sweet syndrome, Schnitzler syndrome, pyoderma gangrenosum, hidradenitis suppurativa, recurrent pericarditis, others.
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