There are indeed a long list of diseases or medical conditions that can affect anyone of any age and exist in many parts of the world. Healthcare professionals are trained to understand these conditions and provide treatment that can help patients to have a good quality of life. Medicine is part of treatment that is important to provide relief for patient from their sickness. In this DoctorOnCall’s article, we will be learning about rilonacept and its uses.
Rilonacept is used to treat many diseases such as recurrent pericarditis, Cryopyrin-Associated Periodic Syndrome (CAPS) including Familial Cold Auto-Inflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS), and Deficiency of IL-1 Receptor Antagonist (DIRA). Rilonacept is available in forms of powder that need to be prepared first before used as injection.
Rilonacept belongs to the drug class of IL-1 inhibitors. IL-1 or interleukin 1 is a highly potent proinflammatory mediator or substance that is important in immune defence or immune-mediated disease. Understanding IL-1 can help you understand the mode of action of rilonacept itself.
IL-1 is mainly produced by macrophages during defensive reactions. It is considered as a master regulator as it controls a variety of innate immune processes. Innate immunity is the first line of defence against invading pathogens and the one people are born with. IL-1 was first described as protein inducing fever and was called human leukocytic pyrogen. IL-1 plays an important role in coordination of local and system inflammation by causing inflammation and induce other proinflammatory genes such as COX type II, other cytokines and chemokines. It mainly acts by binding to the specific receptors on the plasma membrane of target cells. Hence, IL-1 has been an early target in therapy for a number of diseases.
To better understand how rilonacept works, firstly, we have to understand the nature of the diseases. Below are list of diseases and how IL-1 affect the body:
- CAPS- The inflammation in CAPS is associated with mutations in the NLRP-3 gene that encodes protein cryopyrin, an important component of regulating the innate immune system and inflammatory signalling. Mutations of the gene result in excessive release of activated IL-1 that trigger inflammation.
- DIRA- It is caused by loss of function mutations in the IL1RN gene that encodes IL-1 receptor antagonist, resulting in unstoppable signalling of the proinflammatory cytokines IL-1 through the IL-1 receptor.
- Pericarditis- Preformed IL-1 is released by damaged/pericardial cells. This leads to amplification of the inflammation via activation of NLRP3 inflammasome.
Thus, what rilonacept does is block the IL-1 signal from binding to the IL-1 receptor. This will prevent interaction with the cell-surface receptor, therefore reducing the inflammatory process.
It is important for patients to take note that taking rilonacept may affect their immune system and lower the ability of the immune system to fight infections. Thus, when patients have any signs of infections, they should get checked by doctors. This is important to avoid serious infections as usage of rilonacept in serious infections may lead to life-threatening infections. Patients should not begin treatment with rilonacept if they have an infection or have an infection that keeps coming back (chronic infection).
Patients are advised not to take other medicines that block IL-1 such as anakinra or medicine that block tumour necrosis factor such as adalimumab or infliximab. Taking any of these medications on top of rilonacept can increase risk of getting serious infection. Patients should also ask their doctor if they need to take vaccines first before using rilonacept. Some other medication may cause potential drug reactions. Medications such as corticosteroids and blood thinning medication need to be careful when using them together with rilonacept. Patients are advised to bring a list of medications and supplements they are taking when meeting a doctor. This helps doctors identify what medication should be stopped or continue to be taken.
Although medication does have benefits, there is no medicine that does not have potential side effects. It is worth noting that doctors will always prescribe medications that give therapeutic effects with less to none side effects. Common side effects include reactions to the injected site such as pain, redness, swelling, itching, bruising, lumps, blisters, warmth, skin rash and bleeding, upper respiratory tract infection, joint and muscle aches, ear infection, sore throat and runny nose. These side effects should not be serious but should it get worse or severe, patients should talk to their healthcare provider. However, signs such as allergic reactions, breathing problems and infections should be taken seriously and patients need to get immediate medical attention.
In essence, rilonacept is a drug belonging to the drug class of IL-1 inhibitors. Rilonacept is used to treat many diseases which majorly revolves around the immune system or inflammation reaction. This medicine needs to be taken as directed by doctors. This includes following the exact doses and frequency of taking it in a day. Patients are advised to keep using the medicine until their doctor tells them to stop.
