Anakinra as rescue therapy for steroid-dependent idiopathic recurrent pericarditis in children: case report and literature review

Rodríguez-González, Moisés; Ruiz-González, Estefanía; Castellano-Martínez, Ana

doi:10.1017/s1047951118002020

Cited by 9 publications

(11 citation statements)

References 10 publications

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“…Treatment with an anti-mouse IL-1β antibody at different stages of enteroviral infection prevented the development of chronic viral myocarditis by reducing inflammation, interstitial fibrosis and adverse cardiac remodelling in mice 274 . One clinical trial 275 and several case series 276,277 support the use of an anti-IL-1β monoclonal antibody for the treatment of recurrent pericarditis. The ongoing ARAMIS 278 and RHAPSODY 279 trials are designed to assess the efficacy of IL-1β-blocking agents in patients with myocarditis and associated pericarditis.…”

Section: Anti-il-1β and Anti-il-1 Receptor Antibodiesmentioning

confidence: 99%

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

et al. 2020

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Inflammatory cardiomyopathy is defined as myocarditis in association with cardiac dysfunction and ventricular remodelling 1,2. Despite extensive research and improved diagnosis and understanding of the pathogenesis of inflammatory cardiomyopathy, this disorder is still associated with a poor prognosis when complicated by left ventricular (LV) dysfunction, heart failure (HF) or arrhythmia 3. Furthermore, fulminant myocarditis, a rare, sudden and severe cardiac inflammation, is one of the main causes of cardiogenic shock in young adults 4,5. Prompt diagnosis and specific treatment strategies are needed to reduce mortality and the need for heart transplantation in these patients 4,5. Many questions remain unanswered regarding the pathogenesis of inflammatory cardiomyopathy and the role of the viral infection, the immune system, the host genetic background and the environment in disease progression and prognosis. These gaps in knowledge highlight the need for advanced experimental systems that can better model the human immune system and the need to improve the characterization and classification of the patients, for example, with the use of phenomapping and phenomics, which involve detailed evaluation of immune status, viral presence and/or other biomarkers. In this Review, we discuss the available evidence and identify the gaps in our understanding of the pathogenesis, diagnosis, treatment and prognosis of myocarditis and inflammatory cardiomyopathy, appraise the available animal and cell models of these conditions and propose future directions for the field. We discuss the role

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Section: Anti-il-1β and Anti-il-1 Receptor Antibodiesmentioning

confidence: 99%

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

et al. 2020

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“…19,24 Patients in RHAPSODY exhibited signs of inflammatory disease (ie, elevated CRP) and were also receiving standard background therapy with high-dose NSAIDs, colchicine, and/or glucocorticoids, with at least 2 recurrences of pericarditis. 14 Compared with placebo, rilonacept was associated with a lower risk of recurrence, more persistent clinical response at 16 weeks, and a higher amount of days with no or minimal pericarditis symptoms, decreasing patient and disease burden. 24 Rilonacept also had a median time to pain response of 5 days, as well as a median time to normalization of CRP of 7 days.…”

Section: Relevance Of Rilonacept To Patient Care and Clinical Practicementioning

confidence: 95%

“…23,24 Treatment with rilonacept was also associated with sustained reduction in CRP, with a median time to normalization of 7 days. 14…”

Section: Pharmacokinetics and Pharmacodynamics Of Rilonaceptmentioning

confidence: 99%

“…Bailout rilonacept was used as rescue medication for qualifying recurrence events (numerical rating scale score of ≥4 and CRP level of ≥1 mg/dL). The median duration of rilonacept treatment, including the run-in period, was 9 months (range, [3][4][5][6][7][8][9][10][11][12][13][14]. The mean (±SD) adherence to the trial regimen was 98.7 ± 4.6% throughout the run-in and randomized-withdrawal periods.…”

Section: Rilonacept Inhibition Of Interleukin-1α and Interleukin-1β F...mentioning

confidence: 99%

“…9 However, contemporary practice of treating RP involves the use of cytokine blockade, which is being utilized to more specifically target the inflammatory cascade that is responsible for the morbidity associated with RP. [10][11][12][13][14][15][16][17][18] The purpose of this review is to describe the interleukin (IL) cytokine trap-rilonacept. 19 Rilonacept was recently approved by the Food and Drug Administration (FDA) under the orphan drug act.…”

Section: Introductionmentioning

confidence: 99%

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Rilonacept: A Newly Approved Treatment for Recurrent Pericarditis

Schwier

2021

Ann Pharmacother

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Objective To review the pharmacology, efficacy, and safety of rilonacept for the prevention and treatment of recurrent pericarditis (RP). Data Sources A MEDLINE search was conducted between January 2006 and April 2021 using the following terms: rilonacept, pharmacology, pericarditis, recurrent pericarditis, interleukin (IL) antagonist, and pharmacology; prescribing information was also used. Study Selection and Data Extraction English-language studies assessing pharmacology, efficacy, and safety of IL antagonists were reviewed. Data Synthesis Rilonacept traps IL-1α and IL-1β. In the Phase III trial, rilonacept was associated with a lower risk of recurrence, more persistent clinical response, and higher amount of days with no or minimal pericarditis symptoms, compared with placebo. The median time to pain response was 5 days, and median time to normalization of C-reactive protein was 7 days with rilonacept. All patients receiving rilonacept during the run-in period were able to be weaned off of standard background therapy, leading to transition to rilonacept monotherapy. The most common adverse effects were upper respiratory tract infections and injection site reactions. Relevance to Patient Care and Clinical Practice Rilonacept may be used for the prevention and treatment of multiple recurrences in patients receiving background therapy for RP, and reduction in risk of recurrence in adults and adolescents ≥12 years with elevated C-reactive protein. Rilonacept may be considered to wean patients from standard background therapy. Conclusion Rilonacept is a safe, once weekly, subcutaneously administered IL-1 “trap,” indicated for the treatment of RP, and reduction in risk of recurrent pericarditis in adults and children ≥12 years of age.

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Pediatric Pericarditis: Update

et al. 2023

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Purpose of Review While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. Recent Findings We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Summary Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. Case Vignette A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.

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Anakinra as rescue therapy for steroid-dependent idiopathic recurrent pericarditis in children: case report and literature review

Cited by 9 publications

References 10 publications

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

Rilonacept: A Newly Approved Treatment for Recurrent Pericarditis

Pediatric Pericarditis: Update

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