Canakinumab for recurrent rheumatic disease associated-pericarditis: a case series with long-term follow-up

Kougkas, Nikolaos; Fanouriakis, Antonis; Papalopoulos, Ioannis; Βertsias, George; Avgoustidis, Nestor; Repa, Argyro; Sidiropoulos, Prodromos

doi:10.1093/rheumatology/key077

Cited by 38 publications

(45 citation statements)

References 7 publications

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“…In resistant forms, multidrug therapy should be considered, adding ASA or NSAIDs or colchicine to steroids, even if the optimal treatment has not yet been established. e treatment with immunosuppressive agents (azathioprine, cyclosporine, cyclophosphamide, and methotrexate) [36,37], IVIG, anakinra [38] (IL-1 receptor antagonist), and canakinumab [39] (IL-1β blocking monoclonal antibody), may be considered only in cases of recurrent pericarditis which is refractory or intolerant to conventional treatments, but data for their use are limited, and should be tailored to the specific individual patients. Finally, pericardiectomy may be performed for frequent and highly symptomatic recurrences of pericarditis, which is resistant to medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids for Acute and Recurrent Idiopathic Pericarditis: Unexpected Evidences

Perrone

Castrovilli

Piazzolla

et al. 2019

Cardiology Research and Practice

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Pericarditis is a common disease, often postviral or “idiopathic,” diagnosed in about 5% of emergency room visits for non-ischemic chest pain. Although pericarditis often occurs as a benign and self-limiting disease, it may present recurrences. The first-line therapy includes aspirin/nonsteroidal anti-inflammatory drugs (ASA/NSAIDs) plus colchicine. Steroids especially at high-dose have been associated with a higher recurrence rate. In this retrospective study, we evaluated efficacy and safety of ASA/NSAIDs and prednisone in the treatment of acute or recurrent idiopathic pericarditis (colchicine was off-label in the period of the study). The cohort included 276 patients diagnosed with acute idiopathic pericarditis. Mean age was 45.4 ± 12.7 years, and males were significantly higher in number and younger than females. Sixty-one patients (22.1%) were treated with prednisone and 215 with ASA/NSAIDs (77.9%). 171 patients experienced at least one recurrence (62%). No difference in recurrence rate was observed (p=0.257) between the groups treated with prednisone (55.7%) vs. ASA/NSAIDs (63.7%). The recurrences were treated with steroids at low doses and very gradual tapering, and the dose reduction was slower as the number of relapses was higher. Steroids alone were administered to about 80% of patients, while in the remaining 20% of cases, they were associated with ASA/NSDAIDs or colchicine. Approximately 90% of patients had a very favorable course, that is no more than 2 relapses and no patients presented serious side effects. Steroids at low dose, did not act, surprisingly, as an independent risk factor for recurrences and therefore may be considered a successful and safe treatment for acute and recurrent idiopathic pericarditis.

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Section: Discussionmentioning

confidence: 99%

Corticosteroids for Acute and Recurrent Idiopathic Pericarditis: Unexpected Evidences

Perrone

Castrovilli

Piazzolla

et al. 2019

Cardiology Research and Practice

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“…Furthermore, colchicine, drug extensively used in FMF patients, has shown to decrease recurrences in patients with idiopathic pericarditis and it is frequently administered in combination with NSAIDs [ 193 ]., The AIRTRIP randomized trial demonstrated the efficacy of anakinra in difficult to treat patients with recurrent pericarditis [ 194 ]. More recently canakinumab has been also used in pericarditis [ 195 ]. For all these reasons, the role of innate immune in the pathogenesis of idiopathic pericarditis is becoming prominent.…”

Section: Autoinflammatory Diseases Without An Identified Monogenic Etmentioning

confidence: 99%

Periodic fever syndromes and the autoinflammatory diseases (AIDs)

Marino

Tirelli

Giani

et al. 2020

Journal of Translational Autoimmunity

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Innate immune system represents the ancestral defense against infectious agents preserved along the evolution and species; it is phylogenetically older than the adaptive immune system, which exists only in the vertebrates. Cells with phagocytic activity such as neutrophils, macrophages, and natural killer (NK) cells play a key role in innate immunity. In 1999 Kastner et al. first introduced the term “autoinflammation” describing two diseases characterized by recurrent episodes of systemic inflammation without any identifiable infectious trigger: Familial Mediterranean Fever (FMF) and TNF Receptor Associated Periodic Syndrome (TRAPS). Autoinflammatory diseases (AIDs) are caused by self-directed inflammation due to an alteration of innate immunity leading to systemic inflammatory attacks typically in an on/off mode. In addition to inflammasomopathies, nuclear factor (NF)-κB-mediated disorders (also known as Rhelopathies) and type 1 interferonopathies are subjects of more recent studies. This review aims to provide an overview of the field with the most recent updates (see “Most recent developments in..” paragraphs) and a description of the newly identified AIDs.

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“…В отличие от приобретенного иммунитета, при врожденном отсут ствуют специфические антиген-распознающие рецепторы. Идентификация патогенного агента осуществляется через ограниченное количество универсальных рецепторов (pattern recognition receptors), к которым, относятся Toll-подобные рецепторы [15] Показано, что рецидивирующий перикардит может быть одним из ведущих симптомов целого ряда АВЗ, таких как средиземноморская лихорадка, периодический синдром, ассоциированный с мутацией гена рецептора фактора некроза опухоли альфа (TRAPS), болезнь Стилла и многих других [18][19][20]. Высказано предположение, что в ряде случаев за клиническими проявлениями ИРП может стоять маломанифестная форма классических АВЗ, связанных с наличием низкопенетрантных мутаций.…”

Section: роль врожденного звена иммунитетаunclassified

“…Поражения сердца от субклинических до манифестных форм встречаются более чем в 50% случаев [28]. Зачастую поражение перикарда выходит на первый план, имитируя ИРП [18,19]. Применение сетов критериев болезни Стилла для ИРП позволяет выявить пациентов с неполной клинической картиной болезни Стилла взрослых [20], например, не имеющих суставного синдрома и высыпаний, с превалирующим поражением серозных оболочек.…”

Section: роль врожденного звена иммунитетаunclassified

“…Третий препарат из этой группы -канакинумаб, был одобрен FDA для криопинин-ассоциированных периодических синдромов в 2009г, болезни Стилла в 2013г, TRAPS, синдрома гипериммуноглобулина D (дефицит мевалонаткиназы) и семейной средиземноморской лихорадки в сентябре 2016г. В 2018г Kougkas N, et al [18] опубликовали серию случаев, включающих 3 пациентов с болезнью Стилла с преимущественным поражением перикарда в варианте рециди-вирующего перикардита. В качестве третей линии терапии у всех пациентов был с успехом использован канакинумаб, что позволило отказаться от терапии стероидными гормонами.…”

Section: терапевтические подходыunclassified

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Idiopathic recurrent pericarditis — a paradigm shift?

et al. 2019

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Идиопатический рецидивирующий перикардит (ИРП)-относительно редкое воспалительное заболевание перикарда, часто требующее оказания неотложной медицинской помощи, ассоциированное с высоким процентом временной нетрудоспособности и значительными экономическими затратами. В обзоре представлены различные точки зрения на патогенез рецидивирующего перикардита, обсуждается роль аутовоспаления в его развитии, затрагиваются вопросы лечения, основанные на современных данных об иммунопатогенезе ИРП, рассматриваются перспективные направления лабораторной диагностики.

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Canakinumab for recurrent rheumatic disease associated-pericarditis: a case series with long-term follow-up

Cited by 38 publications

References 7 publications

Corticosteroids for Acute and Recurrent Idiopathic Pericarditis: Unexpected Evidences

Corticosteroids for Acute and Recurrent Idiopathic Pericarditis: Unexpected Evidences

Periodic fever syndromes and the autoinflammatory diseases (AIDs)

Idiopathic recurrent pericarditis — a paradigm shift?

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