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Anakinra for constrictive pericarditis associated with incessant or recurrent pericarditis
Alessandro Andreis1, Massimo Imazio2,3, Carla Giustetto4
1University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
Heart (British Cardiac Society)
|September 2, 2020
Summary
Anakinra, an interleukin-1 inhibitor, shows promise in reversing constrictive pericarditis (CP) in patients with recurrent or incessant pericarditis resistant to other treatments. An incessant disease course significantly increases the risk of developing CP.
Area of Science:
- Cardiology
- Immunology
- Internal Medicine
Background:
- Recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance poses a risk for developing constrictive pericarditis (CP).
- Identifying effective third-line treatments for CP is crucial to prevent severe outcomes and the need for surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of anakinra, an interleukin-1 inhibitor, as a third-line treatment for constrictive pericarditis (CP).
- To assess anakinra's role in potentially reversing CP and preventing pericardiectomy in patients with refractory pericarditis.
Main Methods:
- A prospective cohort study included 39 patients with recurrent/incessant pericarditis, corticosteroid dependence, and colchicine resistance.
- Patients received anakinra 100 mg daily subcutaneously, with clinical and echocardiographic follow-up.
- The primary endpoint was the diagnosis of constrictive pericarditis (CP).
Main Results:
- Constrictive pericarditis (CP) was diagnosed in 8 out of 39 patients (20%) during follow-up.
- Anakinra led to complete resolution of CP in 63% of affected patients within a median of 1.2 months.
- CP occurred in 28% of patients with an incessant disease course, which was associated with a significantly increased risk of CP development.
Conclusions:
- Anakinra demonstrates potential in reversing constrictive pericarditis (CP) in patients with recurrent or incessant pericarditis.
- An incessant pericarditis course is a significant risk factor for developing constrictive pericarditis (CP).
- Anakinra represents a viable therapeutic option for refractory CP, potentially averting the need for pericardiectomy.
Keywords:
pericardial constriction
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