Rilonacept

What is Rilonacept

Rilonacept (Arcalyst™, Interleukin-1 Trap) is an interleukin-1 inhibitor that is the first FDA-approved treatment for cryopyrin-associated periodic syndromes (CAPS) including familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS) in adults and children at least 12 years of age. Cryopyrin-associated periodic syndromes is a spectrum of rare, inherited autoinflammatory conditions.

The autoinflammatory diseases are characterized by spontaneous and environmentally triggered systemic inflammation. Symptoms may include fever, chills, rash, fatigue, joint pain, and eye redness.

Symptoms of CAPS are hard to treat; corticosteroids may provide limited relief. Long-term sequelae of CAPS may include amyloidosis and neurologic/intellectual impairment. In a study, 160 mg SC once weekly to patients with either FCAS or MWS led to significant improvement in the disease activity score as compared with scores from placebo recipients.

Also, rilonacept recipients had a 93% reduction in their serum amyloid A concentration whereas placebo recipients had a 0% change.

Continued rilonacept receipt for 9 weeks maintained the reduced disease activity score and serum amyloid A concentration. In contrast, rilonacept cessation led to an increased disease activity score and serum amyloid A concentration.

Rilonacept was FDA approved in February 2008.

Brand Name

Arcalyst

Indications

  • cryopyrin-associated periodic syndromes (CAPS)

For the treatment of cryopyrin-associated periodic syndromes (CAPS) including familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS)

Side Effects

  1. antibody formation
  2. bleeding
  3. cough
  4. ecchymosis
  5. edema
  6. erythema
  7. hypercholesterolemia
  8. hypertriglyceridemia
  9. infection
  10. injection site reaction
  11. new primary malignancy
  12. pruritus
  13. rash
  14. sinusitis
  15. urticaria

Monitoring Parameters

  • serum lipid profile
  • serum triglycerides

Contraindications

  • acquired immunodeficiency syndrome (AIDS)
  • asthma
  • bone marrow suppression
  • breast-feeding
  • children
  • diabetes mellitus
  • geriatric
  • hamster protein hypersensitivity
  • hepatitis
  • human immunodeficiency virus (HIV) infection
  • hypercholesterolemia
  • hypertriglyceridemia
  • immunosuppression
  • infants
  • infection
  • intramuscular administration
  • intravenous administration
  • neonates
  • pregnancy
  • tuberculosis
  • vaccination

Interactions

  • Adalimumab
  • Anakinra
  • Antithymocyte Globulin
  • Azathioprine
  • Bacillus Calmette-Guerin Vaccine, BCG
  • Basiliximab
  • Canakinumab
  • Certolizumab pegol
  • Cyclophosphamide
  • Cyclosporine
  • Dexamethasone
  • Efalizumab
  • Etanercept
  • Golimumab
  • Infliximab
  • Influenza Virus Vaccine
  • Intranasal Influenza Vaccine
  • Live Vaccines
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Measles/Mumps/Rubella Vaccines, MMR
  • Methotrexate
  • Methylprednisolone
  • Muromonab-CD3
  • Prednisone
  • Rotavirus Vaccine
  • Rubella Virus Vaccine Live
  • Smallpox and Monkeypox Vaccine, Live, Nonreplicating
  • Smallpox Vaccine, Vaccinia Vaccine
  • Tumor Necrosis Factor modifiers
  • Typhoid Vaccine
  • Varicella-Zoster Virus Vaccine, Live
  • Warfarin
  • Yellow Fever Vaccine, Live