Anakinra for the Management of Resistant Idiopathic Recurrent Pericarditis in Adults

Dimitrios Vassilopoulos¹, Panagiotis Vasileiou², Christos Koutsianas¹, Katerina Antonatou³, Christina Tsalapaki¹, Dimitrios Pectasides⁴ and George Lazaros⁵, ¹2nd Department of Medicine and Laboratory of Clinical Immunology-Rheumatology, Hippokration General Hospital, University of Athens Medical School, Athens, Greece, ²Department of Cardiology, University of Athens Medical School, Athens, Greece, ³2nd Department of Medicine and Laboratory, Hippokration General Hospital, Hippokration General Hospital, Athens, Greece, ⁴2nd Department of Medicine and Laboratory, Hippokration General Hospital, University of Athens Medical School, Athens, Greece, ⁵Department of Cardiology, Hippokration General Hospital, Athens, Greece

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Autoinflammatory Disease and interleukins (IL)

Session Information

Title: Miscellaneous Rheumatic and Inflammatory Diseases

Session Type: Abstract Submissions (ACR)

Background/Purpose

Recurrent idiopathic pericarditis is currently considered as an auto-inflammatory disorder which is frequently either resistant to standard therapy (with NSAIDs, colchicine or corticosteroids-CS) or requires long term treatment with high doses of CS. Interleukin-1 (IL-1) inhibition has shown encouraging results in pediatric cases and a few adult cases. The aim of our study was to explore the efficacy and safety of anakinra in adult patients with recurrent idiopathic pericarditis.

Methods

In this open label study, ten patients with idiopathic recurrent pericarditis were included. All were resistant and/or intolerant to previous treatment with aspirin and/or NSAIDs, colchicine and CS while two (20%) had failed azathioprine therapy. Patients were initially treated with daily subcutaneous injections of anakinra (100 mg) with gradual tapering of the administered dose. Recurrences as well as adverse events were recorded in all patients during the follow-up period (24 ± 16 months).

Results

Among the 10 patients included (5 females/5 males, mean age = 42 ± 18 years, mean disease duration=37 ± 22 months), the mean number of recurrences despite standard therapy was 8 ± 3.7 while the baseline mean daily dose of prednisolone was 14.1 ± 7.9 mg. All patients treated with anakinra demonstrated a rapid clinical response with resolution of symptoms and normalization of CRP (mean time=5.9 ± 2.3 days). All patients receiving CS at baseline (n=8) were able to gradually discontinue them (mean time to discontinuation = 53 ± 44 days). Among 7 patients who discontinued anakinra, 5 (70%) relapsed after a mean time of 18 ± 9 days; in 4/5, anakinra was restarted leading again to clinical remission while one was successfully treated with NSAIDs and colchicine. One patient discontinued therapy due to transient elevation of aminotransferases while 6 (60%) demonstrated mild skin reactions at the injection site.

Conclusion

Our study shows that IL-1 inhibition with anakinra is a highly efficacious, safe and steroid-sparing strategy for treatment-resistant recurrent idiopathic pericarditis in adults. Further studies are needed to clarify the appropriate dose and duration of therapy in these patients.

Disclosure:

D. Vassilopoulos,
None;

P. Vasileiou,
None;

C. Koutsianas,
None;

K. Antonatou,
None;

C. Tsalapaki,
None;

D. Pectasides,
None;

G. Lazaros,
None.

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