Systemic JIA: Tapering canakinumab feasible in children in complete remission

For paediatric patients who achieved complete remission (CR) on canakinumab, it is possible to maintain this response while reducing exposure to the drug, as shown in a study.

However, only a few patients could discontinue canakinumab and remain in CR for at least 24 weeks, suggesting that a certain level of IL-1 inhibition may be essential to maintain CR.

The study was conducted in two phases. In the first phase, 182 patients received 4 mg/kg canakinumab subcutaneously every 4 weeks (q4w) and discontinued glucocorticoids and/or methotrexate as appropriate.

Seventy-five of the patients who achieved CR (inactive disease for ≥24 weeks) entered the second phase and were randomly assigned to two groups evaluating canakinumab tapering: arm 1 (dose reduction from 4 to 2 to 1 mg/kg and then discontinuation; n=38) or arm 2 (dose interval prolongation from q4w to q8w to q12w and then discontinuation; n=37).

CR persisted in most patients in arm 1 (71 percent) and in arm 2 (84 percent). These numbers were significantly higher when compared to the proportion of patients who were on CR for 24 weeks in the first study phase (vs 40 percent; p≤0.0001 for each arm).

However, in the combined arms, only 33 percent patients were able to discontinue canakinumab and remain in CR for at least 24 weeks.

There were no new safety signals identified.