Canakinumab for Adult-Onset Still Disease

Key Message

This review identified limited evidence from 2 systematic reviews about the clinical effectiveness and safety of canakinumab for patients with adult-onset Still disease (AOSD). Most studies in the systematic reviews on AOSD did not have a control group; therefore, the findings related to the effectiveness and safety of canakinumab in this population are uncertain. For adults with AOSD, treatment with canakinumab may be associated with a complete or partial response to treatment, corticosteroid-sparing effect, and a decrease or normalization of key laboratory parameters, such as leukocyte count, erythrocyte sedimentation rate, and serum levels of ferritin and C-reactive protein, compared with baseline. In adults with AOSD, limited evidence suggested there was no statistically significant difference between canakinumab and placebo in articular manifestations. Adverse events associated with canakinumab treatment included infections, leukopenia, musculoskeletal and connective tissue disorders, skin disorders, thoracic and mediastinal disorders, gastrointestinal disorders, and site injection reactions. Severe adverse events included macrophage activation syndrome, hepatocytotoxicity, and serious infections that led to discontinuation of treatment. No studies were found comparing canakinumab and alternative pharmacologic treatments for AOSD. No studies were found on the cost-effectiveness of canakinumab for the treatment of AOSD. No evidence-based guidelines were found on the use of canakinumab for the treatment of ASOD.