IL-1 Inhibitors

Mechanism of Action
  • Recombinant human IL1 receptor antagonist
Dose
  • Subcutaneous
  • Adults: 100 mg daily
  • Children: 1-2 mg/kg 
  • Dose need to be adjusted in renal failure
Pregnancy Category
  • Pregnancy Category B
Off Label uses
  • -CAPS (cryopyrin-associated periodic syndrome) especially NOMID (neonatal onset multisystem inflammatory disease)
  • DIRA (deficiency of the interleukin-1 receptor antagonist)
  • Hidradenitis suppurativa
  • DITRA (deficiency of interleukin-36 receptor antagonist)
  • SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis)
  • Schnitzler 
  • Pyoderma gangrenosum 
  • PAPA (pyogenic arthritis, pyoderma gangrenosum and acne)
Side effects
  • Injection site reaction
  • Flu like symptoms
  • Increase risk of infection
  • Serious:
    • Neutropenia and thrombocytopenia
Contraindications
  • Hypersensitivity reaction
  • Infection 
Notes
  • All patients on IL1 antagonists should be screened at baseline and annually for tuberculosis
  • Combination with TNF alpha inhibitors should be avoided 
  • CBC monthly for 3 months then every 3 months 

Mechanism of Action
  • IgG1 kappa that bind and neutralize IL1 beta
Dose
  • Subcutaneous
  • Weight based:
    • >40kg: 150-300 mg q4-8weeks
    • 15-40kg: 2-4 mg/kg
Pregnancy Category
  • Pregnancy Category C
Off Label uses
  • CAPS (cryopyrin-associated periodic syndrome) especially NOMID (neonatal onset multisystem inflammatory disease)
  • DIRA (deficiency of the interleukin-1 receptor antagonist)
  • Hidradenitis suppurativa
  • TRAPS (Tumor Necrosis Factor Receptor Associated Periodic Syndrome)
  • Hyper IgD syndrome
  • Familial Mediterranean Fever
  • Generalized pustular psoriasis
  • Schnitzler
  • PAPA (pyogenic arthritis, pyoderma gangrenosum and acne)
Side effects
  • Injection site reaction
  • Flu like symptoms
  • Increase risk of infection
Contraindications
  • Hypersensitivity reaction
  • Infection 
Notes
  • All patients on IL1 antagonists should be screened at baseline and annually for tuberculosis
  • Combination with TNF alpha inhibitors should be avoided 
  • CBC monthly for 3 months then every 3 months

Mechanism of Action
  • Fusion protein extracellular domain contain IL1 receptor and FC IgG1
  • Prevent IL1beta signaling by acting as a soluble receptor
  • Also has affinity to IL1 alpha
Dose
  • Subcutaneous
  • Adults: 320 mg loading dose followed 160 mg weekly
  • Children: 4.4mg/kg followed by 2.2 mg/kg weekly
Pregnancy Category
  • Pregnancy Category C
Off Label uses
  • CAPS (cryopyrin-associated periodic syndrome) especially NOMID (neonatal onset multisystem inflammatory disease)
  • DIRA (deficiency of the interleukin-1 receptor antagonist)
  • Schnitzler
Side effects
  • Injection site reaction
  • Flu like symptoms
  • Increase risk of infect
Contraindications
  • Hypersensitivity reaction
  • Infection
Notes
  • All patients on IL1 antagonists should be screened at baseline and annually for tuberculosis
  • Combination with TNF alpha inhibitors should be avoided 
  • CBC monthly for 3 months then every 3 months