Canakinumab in the Treatment of Erosive Hand Osteoarthritis: A Case Series

Background: Erosive hand Osteoarthritis (EOA) is a common and debilitating form of hand OA for which there are no proven or efficacious therapies. Interleukin-1 beta (IL-1β) plays a prominent role in OA joint inflammation. Canakinumab is a selective IL-1β inhibitor. The author hypothesized that canakinumab would be effective in alleviating the symptoms and functional limitations of EOA. Methods: This prospective case series enrolled 3 patients with EOA who were treated with canakinumab 160 mg subcutaneously once. They were followed over a 12 week period, with visits at week 4, week 8, and week 12. It was anticipated that the effect of canakinumab would wear off and pain/function would return to baseline at week 12. The primary outcome of the study was improvement in QuickDASH at week 8. Secondary outcomes included changes in Health Assessment-Disability Index, subject reported pain, grip strength, and shirt button time. Subjects also had swollen and tender joint counts recorded. Erythrocyte Sedimentation Rate and C-Reactive Protein were measured. Results: No clinical or statistically significant improvement in QuickDASH, the primary study outcome, was noted. A minor trend in improvement was noted in shirt button time, but this improvement was not statistically significant. All other outcomes did not demonstrate any clinically or statistically significant trends. Conclusion: No clinical improvements in the various functional and clinical parameters studied were noted. The lack of effect of canakinumab and the small size of the trial should not dissuade future research.