Anaphylactic reaction to anakinra in a child with steroid-dependent idiopathic recurrent pericarditis and successful management with canakinumab

Epçaçan, Serdar; Şahin, Sezgin; Kasapçopur, Özgür

doi:10.1017/s1047951119000672

Cited by 36 publications

(22 citation statements)

References 10 publications

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“…Canakinumab has demonstrated efficacy in controlling FMF flare recurrence in patients resistant to colchicine but has primarily been studied for management of other autoinflammatory conditions. 10–14 Studies reporting management of urticarial vasculitis, systemic juvenile idiopathic arthritis, for which is it also FDA-approved, and idiopathic recurrent pericarditis with canakinumab have indicated successful outcomes. 4,11–14 To our knowledge, a canakinumab desensitization protocol does not exist in the literature; however, several protocols for a mechanistically similar biologic, anakinra, do exist.…”

Section: Discussionmentioning

confidence: 99%

Expedited Desensitization to Canakinumab

Sanan

Schend

Rowane

et al. 2020

Allergy�Rhinol (Providence)

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Introduction Interleukin-1 (IL-1) antagonists have been successful in the management of monogenic auto-inflammatory diseases, notably classic hereditary fever syndromes, such as Familial Mediterranean Fever (FMF). Anakinra (Kineret®), a human recombinant IL-1 receptor antagonist (IL-1Ra), has been clinically effective in the management of persistent auto-inflammation, such as FMF. Few studies report anaphylaxis in response to anakinra, which were resolved with an anakinra desensitization or the anti-IL-1β monoclonal antibody canakinumab (ILARIS®). We describe the first reported desensitization protocol to canakinumab. Case Report A 51-year-old man with a prior history of FMF presented with history of failed colchicine, nonsteroidal anti-inflammatory drug, and anakinra trials. Anakinra desensitization and canakinumab intradermal testing (IDT) resulted in anaphylactic and allergic symptoms, respectively. Expedited desensitization to canakinumab was successfully performed with 15-minute intervals between 13 doses of incremental increase to 150 mg. Discussion Biological agents are immune modulators that may evoke unanticipated hypersensitivity reactions, including anaphylaxis. These anaphylactic reactions to biologics have been infrequently reported, but the expanding market may increase the risk of IgE-mediated hypersensitivities and subsequent need for desensitization protocols. The current, expedited desensitization evaluated several published protocols involving anakinra desensitization to determine appropriate dosing for canakinumab. Conclusion We report the gastrointestinal intolerance and continued FMF flares on colchicine, followed by anaphylactic responses to anakinra and allergic reaction to IDT of canakinumab, in the present case of FMF. Our novel, expedited canakinumab desensitization protocol serves as an effective and alternative therapy in cases when other appropriate biologic agents are not tolerated.

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Section: Discussionmentioning

confidence: 99%

Expedited Desensitization to Canakinumab

Sanan

Schend

Rowane

et al. 2020

Allergy�Rhinol (Providence)

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“…A case series on patients with IRP experiencing injection-site reactions to anakinra suggested the efficacy of canakinumab [46]. In another report of a pediatric patient suffering from IRP, canakinumab was effective in controlling disease recurrences, although an anaphylactic reaction occurred [47]. In conclusion, canakinumab might be considered in subjects allergic or intolerant to anakinra, although its cost is very high.…”

Section: Not Availablementioning

confidence: 98%

Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

et al. 2020

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Recent advances have shown impressive results by anti-interleukin 1 (IL-1) agents in refractory idiopathic recurrent pericarditis. Purpose of ReviewWe critically discuss the current state of the art of therapy of relapsing pericarditis, with a focus on new pharmacological approaches and on specific clinical settings such as pregnancy, pediatric patients, and secondary forms of relapsing pericarditis. Recent FindingsAntagonism of the IL-1 is highly effective in idiopathic recurrent pericarditis with autoinflammatory features. Currently, available anti-IL-1 agents are anakinra and canakinumab. Rilonacept is another IL-1 antagonist, currently studied in the phase-3 clinical trial RHAPSODY. Available data suggest similar efficacy and safety profiles of these three agents, although only anakinra has been tested in randomized clinical trials. These agents have slightly different pharmacological properties, being canakinumab a specific IL-1ß antagonist while anakinra and rilonacept are unselective IL-1α and IL-1ß blockers. To date, there is no evidence that specificity against IL-1ß affects safety and efficacy in patients with relapsing pericarditis, although it has been proposed that unspecific blockage might be useful in severe disease. Summary Anakinra is the first anti-IL-1 agent with well-documented efficacy and safety in adult and pediatric patients with idiopathic relapsing pericarditis. Other anti-IL-1 agents are currently under study. Future research should clarify the optimal duration of therapy and tapering schedule of treatment with these agents. Moreover, biomarkers would be required to understand which patients will benefit from early administration of IL-1 blockers due to refractoriness to conventional therapy and which others will suffer from recurrences during the tapering of these agents. Lastly, future studies should focus on the subjects with the autoimmune or the pauci-inflammatory phenotype of idiopathic refractory pericarditis.

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“…Canakinumab is approved for the treatment of various auto‐inflammatory conditions (colchicine resistant FMF, TRAPS, cryopyrin‐associated periodic syndrome [CAPS] amongst others) but has not been used commonly in pericarditis due to its high cost and scarce data mainly limited to case series with mixed results. 34 , 35 , 36 Canakinumab was used in a case series of 3 adult patients with colchicine‐resistant, corticosteroids‐dependent RP, and previous failed response to biologic agents including anakinra. Two patients were diagnosed with adult‐onset Still’s disease (AOSD) and one with seronegative rheumatoid arthritis, all sharing in common evidence of systemic inflammation.…”

Section: Il‐1 Inhibitorsmentioning

confidence: 99%

“…The combination of colchicine with canakinumab was successful in achieving remission for 2 years. 36 …”

Section: Il‐1 Inhibitorsmentioning

confidence: 99%

Emerging Therapies for Recurrent Pericarditis: Interleukin‐1 inhibitors

Presti

Elajami

Reyaldeen

et al. 2021

JAHA

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Recurrent pericarditis (RP) is a complex inflammatory disorder associated with adverse outcomes and poor quality of life. After the first episode of acute pericarditis, a non‐negligible group of patients will fail to achieve complete remission despite treatment and will be challenged by side effects from the chronic use of medications like corticosteroids. The cause of RP remains unknown in the majority of cases, mainly due to a gap in knowledge of its complex pathophysiology. Over the past 2 decades, the interleukin‐1 (IL‐1) pathway has been uncovered as a key element in the inflammatory cascade, allowing the development of pharmacological targets known as IL‐1 inhibitors. This group of medications has emerged as a treatment option for patients with RP colchicine‐resistance and steroid dependents. Currently, anakinra and rilonacept, have demonstrated beneficial impact in clinical outcomes with a reasonable safety profile in randomized clinical trials. There is still paucity of data regarding the use of canakinumab in the treatment of patients with RP. Although further studies are needed to refine therapeutic protocols and taper of concomitant therapies, IL‐1 inhibitors, continue to consolidate as part of the pharmacological armamentarium to manage this complex condition with potential use as monotherapy. The aim of this review is to highlight the role of IL‐1 pathway in RP and discuss the efficacy, safety, and clinical applicability of IL‐1 inhibitors in the treatment of RP based on current evidence.

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Anaphylactic reaction to anakinra in a child with steroid-dependent idiopathic recurrent pericarditis and successful management with canakinumab

Cited by 36 publications

References 10 publications

Expedited Desensitization to Canakinumab

Expedited Desensitization to Canakinumab

Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

Emerging Therapies for Recurrent Pericarditis: Interleukin‐1 inhibitors

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