Canakinumab is an IL-1β inhibitor used for the treatment of various autoinflammatory diseases.

I. Dosage and Administration of Canakinumab

1. Route of Administration

For subcutaneous use only; intravenous or intramuscular administration is prohibited.

Administration should be performed by a healthcare professional; self-administration is not permitted.

2. CAPS (Cryopyrin-Associated Periodic Syndromes)

(1) Body weight > 40 kg: 150 mg every 8 weeks.

(2) Body weight 15–40 kg: 2 mg/kg every 8 weeks.

(3) Patients 15–40 kg with inadequate response: May increase to 3 mg/kg every 8 weeks.

3. TRAPS, HIDS/MKD, FMF

(1) Body weight > 40 kg: Initial dose 150 mg every 4 weeks; may increase to 300 mg every 4 weeks if response is inadequate.

(2) Body weight ≤ 40 kg: Initial dose 2 mg/kg every 4 weeks; may increase to 4 mg/kg every 4 weeks if response is inadequate.

4. Still’s Disease (AOSD and SJIA)

Body weight ≥ 7.5 kg: 4 mg/kg (maximum 300 mg) every 4 weeks.

5. Gout Flare

Single dose of 150 mg. For retreatment, allow an interval of at least 12 weeks.

6. Pre-Injection Inspection

(1) The solution should be clear to slightly opalescent, colorless to slightly brownish-yellow, and essentially free from visible particles.

(2) Do not use if the solution is distinctly brown, highly opalescent, or contains visible particles.

(3) Avoid injection into scar tissue.

II. Precautions for Canakinumab Use

1. Risk of Infections

(1) May increase the risk of serious infections, predominantly upper respiratory tract infections.

(2) Avoid use during active infection.

(3) Seek immediate medical attention if infection symptoms (fever, cough, fatigue) occur.

(4) Discontinue treatment if a serious infection develops.

2. Tuberculosis (TB) Screening

(1) Mandatory screening for active and latent TB before treatment.

(2) Patients with positive screening results should receive standard anti-TB therapy prior to initiation.

(3) Seek medical advice promptly if signs of TB (persistent cough, weight loss, low-grade fever) develop during treatment.

3. Vaccinations

(1) Complete all recommended vaccinations before treatment, including pneumococcal and inactivated influenza vaccines.

(2) Avoid live vaccines during treatment.

(3) Infants with in utero exposure: Risk assessment is required before live vaccination between 4–12 months after the mother’s last dose.

4. Hypersensitivity and DRESS

(1) Discontinue immediately and seek medical help if rash, itching, dyspnea, or facial/lip swelling occurs.

(2) DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms): Presents as severe rash with eosinophilia and systemic symptoms; requires emergency treatment.

5. Drug Interactions

(1) Combination with TNF inhibitors (e.g., etanercept, adalimumab) is not recommended due to increased risk of serious infections.

(2) When co-administered with narrow therapeutic index CYP450 substrates (e.g., warfarin), monitor drug levels and adjust doses as needed.

III. Healthy Lifestyle for Patients on Canakinumab

1. Infection Prevention

(1) Practice frequent handwashing; avoid contact with infected individuals.

(2) Maintain a clean and well-ventilated home environment.

(3) Seek prompt medical care for early signs of infection (fever, sore throat, cough); do not self-medicate.

2. Balanced Nutrition

(1) Consume adequate high-quality protein (fish, poultry, eggs, legumes) and vitamin-rich fruits/vegetables to support immune function.

(2) For gastrointestinal symptoms (nausea, diarrhea), choose bland, easily digestible foods and eat small, frequent meals.

3. Moderate Exercise

(1) Engage in low-impact activities (walking, yoga, tai chi) based on physical ability; avoid overexertion.

(2) Still’s disease patients: Protect joints; avoid vigorous exercise that may trigger inflammation.

4. Adequate Rest

(1) Ensure 7–8 hours of sleep; avoid late nights.

(2) Take a proper nap when fatigued.

(3) Stress management positively impacts the control of autoinflammatory diseases.