CANAKINUMAB demonstrated significantly greater efficacy and durability than anakinra in the treatment of patients with VEXAS syndrome, according to findings from an international multicenter study.
The study included 47 male patients with VEXAS syndrome across centers in France, Israel, and Italy who were treated with IL-1 inhibition. Of these, 44 received anakinra and 9 received canakinumab, with six patients switching between the two therapies at different time points. Global response, defined as the resolution of inflammatory symptoms together with at least a 50% reduction in steroid dose and C-reactive protein levels, was used as the primary measure of treatment effect.
At 1 month, global response was observed in 34% of patients on anakinra compared with 100% of those on canakinumab. At three months, response rates were 22% and 78%, respectively. Multivariable analysis confirmed that canakinumab use was strongly associated with higher odds of achieving global response at three months (OR: 28.8, 95% CI: 3.0–273.9).
Drug survival analysis further underscored the difference in performance. Median drug survival reached 54 months for patients receiving canakinumab at 300 mg monthly, compared with 7 months for 150 mg canakinumab and only 1 month for anakinra. Safety profiles also differed between treatments. Injection site reactions occurred exclusively in the anakinra group (47% versus none for canakinumab), and infections were more common among anakinra users (31% versus 11%), although the difference was not statistically significant.
The authors conclude that monthly canakinumab at 300 mg offers superior efficacy, longer drug survival, and a more favorable safety profile compared with anakinra, suggesting its potential as an effective steroid-sparing therapeutic option in VEXAS syndrome.
Reference: Eviatar T et al. Comparative efficacy and safety of anakinra and canakinumab in patients with VEXAS syndrome – an international multicenter study. Arthritis Rheumatol. 2025. doi:10.1002/art.43384
