How are IL 1 inhibitors supplied and used

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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