Anakinra for constrictive pericarditis associated with incessant or recurrent pericarditis

Heart. 2020 Oct;106(20):1561-1565. doi: 10.1136/heartjnl-2020-316898. Epub 2020 Aug 31.

Abstract

Objective: Frequent flares of pericardial inflammation in recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance may represent a risk factor for constrictive pericarditis (CP). This study was aimed at the identification of CP in these patients, evaluating the efficacy and safety of anakinra, a third-line treatment based on interleukin-1 inhibition, to treat CP and prevent the need for pericardiectomy.

Methods: Consecutive patients with recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance were included in a prospective cohort study from 2015 to 2018. Enrolled patients received anakinra 100 mg once daily subcutaneously. The primary end point was the occurrence of CP. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months.

Results: Thirty-nine patients (mean age 42 years, 67% females) were assessed, with a baseline recurrence rate of 2.76 flares/patient-year and a median disease duration of 12 months (IQR 9-20). During follow-up, CP was diagnosed in 8/39 (20%) patients. After anakinra dose of 100 mg/day, 5 patients (63%) had a complete resolution of pericardial constriction within a median of 1.2 months (IQR 1-4). In other three patients (37%), CP became chronic, requiring pericardiectomy within a median of 2.8 months (IQR 2-5). CP occurred in 11 patients (28%) with incessant course, which was associated with an increased risk of CP over time (HR for CP 30.6, 95% CI 3.69 to 253.09).

Conclusions: In patients with recurrent or incessant pericarditis, anakinra may have a role in CP reversal. The risk of CP is associated with incessant rather than recurrent course.

Keywords: pericardial constriction.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Echocardiography
  • Female
  • Humans
  • Interleukin 1 Receptor Antagonist Protein / adverse effects
  • Interleukin 1 Receptor Antagonist Protein / therapeutic use*
  • Male
  • Middle Aged
  • Pericarditis / diagnostic imaging
  • Pericarditis / drug therapy*
  • Pericarditis / physiopathology
  • Pericarditis, Constrictive / diagnostic imaging
  • Pericarditis, Constrictive / drug therapy*
  • Pericarditis, Constrictive / physiopathology
  • Prospective Studies
  • Recurrence
  • Remission Induction
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Interleukin 1 Receptor Antagonist Protein