Anakinra for corticosteroid-dependent and colchicine-resistant pericarditis: The IRAP (International Registry of Anakinra for Pericarditis) study

Abstract

Aims Novel therapies are needed for recurrent pericarditis, particularly when corticosteroid dependent and colchicine resistant. Based on limited data, interleukin-1 blockade with anakinra may be beneficial. The aim of this multicentre registry was to evaluate the broader effectiveness and safety of anakinra in a ‘real world’ population. Methods and results This registry enrolled consecutive patients with recurrent pericarditis who were corticosteroid dependent and colchicine resistant and treated with anakinra. The primary outcome was the pericarditis recurrence rate after treatment. Secondary outcomes included emergency department visits, hospitalisations, corticosteroid use and adverse events. Among 224 patients (46 ± 14 years old, 63% women, 75% idiopathic), the median duration of disease was 17 months (interquartile range 9–33). Most patients had elevated C-reactive protein (91%) and pericardial effusion (88%). After a median treatment of 6 months (3–12), pericarditis recurrences were reduced six-fold (2.33–0.39 per patient per year), emergency department admissions were reduced 11-fold (1.08–0.10 per patient per year), hospitalisations were reduced seven-fold (0.99–0.13 per patient per year). Corticosteroid use was decreased by anakinra (respectively from 80% to 27%; P < 0.001). No serious adverse events occurred; adverse events consisted mostly of transient skin reactions (38%) at the injection site. Adverse events led to discontinuation in 3%. A full-dose treatment duration of over 3 months followed by a tapering period of over 3 months were the therapeutic schemes associated with a lower risk of recurrence. Conclusion In patients with recurrent pericarditis, anakinra appears efficacious and safe in reducing recurrences, emergency department admissions and hospitalisations.

Infectious-immune pericarditis: clinical assessment, diagnostics, and differentiated baseline therapy with hydroxychloroquine

“…Типичным для аутовоспаления считают рецидивирующий характер, развитие первых атак в детском возрасте, острый воспалительный ответ с высоким уровнем СРБ и последующим регрессом симптоматики [10]. Ключевым медиатором этого ответа является интерлейкин-1, и эффективность анакинры у некоторых больных с резистентным перикардитом, несомненно, подтверждает роль аутовоспаления [11], как и доказанный противореци-дивный эффект колхицина, модулирующего врожденный иммунный ответ [4]. Эту концепцию поддерживают и отечественные авторы [12].…”

Postpericardiotomy syndrome after cardiac surgery

“…There are anecdotal case reports on the use of methotrexate [168], azathioprine [169,170], as well as high-dose intravenous immunoglobulin [171][172][173][174], in the treatment of steroid-dependent recurrent PPS. Moreover, in chronic recurrent pericarditis, anakinra, a recombinant IL-1b receptor antagonist [175][176][177][178] as well as cyclophosphamide [170] have been successfully used. Furthermore, intrapericardial triamcinolone has been used in the treatment of chronic autoreactive pericardial effusion [179], and it is also mentioned in the ESC guideline as well as azathioprine, intravenous immunoglobulin, and anakinra [15].…”

Perikarditis im Rahmen rheumatologischer Erkrankungen – Was der Rheumatologe wissen sollte

“…In der Registerarbeit des International Registry of Anakinra for Pericarditis (IRAP) konnte bei 224 IRP-Patienten, die Colchicin-resistent und Kortikosteroidabhängig waren, gezeigt werden, dass der Einsatz von Anakinra u. a. eine Verringerung der Rezidivrate um 83 % und eine signifikante Kortikosteroidreduktion ermöglichte [40].…”