Massimo Imazio1, Alessandro Andreis1, Gaetano Maria De Ferrari1, Paul C Cremer2, Vartan Mardigyan3, Silvia Maestroni4, Sushil Allen Luis5, Giuseppe Lopalco6, Giacomo Emmi7, Dor Lotan8, Renzo Marcolongo9, George Lazaros10, Marzia De Biasio11, Luca Cantarini12, Lorenzo Dagna13, Andreja Cerne Cercek14, Emanuele Pivetta15, Beni Varma2, Laeora Berkson3, Enrico Tombetti16, Florenzo Iannone6, Domenico Prisco7, Alida Linda P Caforio9, Dimitrios Vassilopoulos10, Dimitrios Tousoulis10, Giacomo De Luca13, Carla Giustetto1, Mauro Rinaldi1, Jae K Oh5, Allan L Klein2, Antonio Brucato16, Yehuda Adler8. 1. Coordinating Center: University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Italy. 2. Heart and Vascular Institute, Cleveland Clinic, USA. 3. McGill University, Jewish General Hospital, Canada. 4. Internal Medicine Division, Ospedale Papa Giovanni XXIII, Italy. 5. Department of Cardiovascular Medicine, Mayo Clinic, USA. 6. Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy. 7. Department of Experimental and Clinical Medicine, University of Firenze, Italy. 8. Leviev Heart Center, Chaim Sheba Medical Center (affiliated to Tel Aviv University), Israel. 9. Department of Cardiac Thoracic Vascular Sciences and Public Health, Policlinico Universitario, Italy. 10. 1st Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece. 11. Cardiology Department, Udine Hospital, Italy. 12. Research Center of Systemic Autoinflammatory Diseases, University of Siena, Italy. 13. Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Italy. 14. Department of Cardiology, University Medical Center Ljubljana, Slovenia. 15. Emergency Medicine Division and High Dependency Unit and CPO Piemonte, A.O.U. Città della Salute e della Scienza di Torino, Italy. 16. Dipartimento Scienze Cliniche e biomediche Luigi Sacco, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, Italy.
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.
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.
Authors: Antonio Abbate; Stefano Toldo; Carlo Marchetti; Jordana Kron; Benjamin W Van Tassell; Charles A Dinarello Journal: Circ Res Date: 2020-04-23 Impact factor: 17.367
Authors: Allan L Klein; David Lin; Paul C Cremer; Saifullah Nasir; Sushil Allen Luis; Antonio Abbate; Andrew Ertel; Martin LeWinter; Anna Beutler; Fang Fang; John F Paolini Journal: Heart Date: 2020-11-23 Impact factor: 5.994
Authors: Sara Signa; Matteo D'Alessandro; Rita Consolini; Angela Miniaci; Marta Bustaffa; Chiara Longo; Maria A Tosca; Martina Bizzi; Roberta Caorsi; Leonardo Oliveira Mendonça; Andrea Pession; Angelo Ravelli; Marco Gattorno Journal: Pediatr Rheumatol Online J Date: 2020-06-16 Impact factor: 3.054