Canakinumab (IL-1β Inhibitor — Post-MI CV Prevention)

How it works

It neutralises interleukin-1 beta, blocking a key driver of the inflammatory cascade implicated in atherosclerotic plaque instability and recurrent vascular events.

Prescribing in practice

• By suppressing innate immunity it increases susceptibility to serious infection, including fatal sepsis, so it should not be started during active infection and patients must be screened for tuberculosis beforehand.
• Live vaccines should be avoided during treatment, and concurrent use with other biologic immunomodulators is not recommended.
• Its UK licence covers periodic fever syndromes and certain arthritides rather than cardiovascular prevention, where use would be off-label.

Monitoring

Monitor for signs of infection at each contact and review neutrophil counts, with vigilance for tuberculosis reactivation during long-term therapy.

Counselling the patient

• Report fever or any sign of infection without delay.
• Tell clinicians you are on an immunosuppressing biologic before vaccinations or surgery.
• Keep up to date with non-live vaccinations as advised.

Evidence & guidelines

The CANTOS trial showed canakinumab reduced recurrent cardiovascular events independently of lipid lowering but increased fatal infections, and it has not translated into a licensed cardiovascular indication.