The Use of IL-1 Receptor Antagonist (Anakinra) in Idiopathic Recurrent Pericarditis: A Narrative Review

Abstract

Recurrent pericarditis is a complication of acute pericarditis in 20–30% of the patients and is usually idiopathic in nature. The underlying pathogenesis of this condition remains unclear, although immune-mediated mechanisms seem likely. A subgroup of these patients with refractory symptoms can be challenging to manage, and multiple immunosuppressive medications have been used without consistent benefit. Anakinra, an interleukin-1 receptor antagonist, has been used in treatment of rheumatoid arthritis and autoinflammatory syndromes. Preliminary evidence suggests that anakinra could be a promising therapy for idiopathic recurrent pericarditis. In this narrative review, we summarize the current understanding of the etiopathogenesis of idiopathic recurrent pericarditis, mechanism of action of anakinra, and the preliminary evidence, supporting the use of anakinra in pericarditis.

WITHDRAWN: Association Between Inflammatory Biomarkers and Acute Respiratory Distress Syndrome or Acute Lung Injury Risk: A Systematic Review and Meta-analysis

“…[41] Anakinra is an IL-1β antagonist approved by the Food and Drug Administration (FDA) for the treatment rheumatoid arthritis and other autoimmune diseases to reduce clinical symptoms and suppress joint destruction. [90] Determining whether this antagonistic effect can be also observed in ARDS patients is an interesting topic for future research. IL-6 is an acute inflammatory mediator that is released by various cell types.…”

A Snapshot on the On-Label and Off-Label Use of the Interleukin-1 Inhibitors in Italy among Rheumatologists and Pediatric Rheumatologists: A Nationwide Multi-Center Retrospective Observational Study

“…To date, therapeutic indications for ANA include only RA and CAPS, while on-label use of CAN refers to CAPS, SOJA, and gout. Nevertheless, thanks to vivid basic and clinical research efforts, innate immunity has recently proven to have an important role in a wide number of disorders beyond monogenic AIDs (Banerjee and Saxena, 2012 ; Dickie et al, 2012 ; Vitale et al, 2012 ; Caso et al, 2013 ; Sheedy and Moore, 2013 ; Van Tassell et al, 2013 ; Baskar et al, 2016 ). Sure enough, inflammatory pathways of innate immunity have been found to affect a lot of pathologies previously classified as exclusively belonging to the field of adaptive immune disorders or degenerative diseases (Martinon et al, 2006 ; Rigante et al, 2011 ; Kotas et al, 2013 ; Ruscitti et al, 2015 ; Thueringer et al, 2015 ).…”

Pediatric Pericarditis Case Report

“…Recurrence of pericarditis in children ranges from 15% to 40% (Shakti et al, 2014). For adults and pediatric patients with refractory recurrent pericarditis, there are studies demonstrating safety and efficacy of interleukin-1 receptor antagonists (Baskar, Klein, & Zeft, 2016). Further studies are needed to address the role of colchicine and newer anti-inflammatory agents in pediatric pericarditis and pericardial effusion.…”