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Rilonacept and Other Interleukin-1 Inhibitors in the Treatment of Recurrent Pericarditis.
Akshay Goel1, Dhrubajyoti Bandyopadhyay1, Aaqib H Malik1
1Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY.
Cardiology in Review
|November 18, 2022
Summary
Recurrent pericarditis, often refractory to standard treatments, can be effectively managed with interleukin-1 (IL-1) inhibitors like rilonacept and anakinra. These targeted therapies offer new hope for patients with this debilitating condition.
Area of Science:
- Cardiology
- Immunology
- Rheumatology
Background:
- Pericarditis is a common pericardial disease with a significant recurrence rate (15-30%) despite optimal treatment.
- Recurrent pericarditis leads to corticosteroid dependence and impaired quality of life, driven by inflammasome activation and interleukin-1 (IL-1) overproduction.
- IL-1 pathway dysregulation is implicated in the pathogenesis of recurrent autoinflammatory pericarditis.
Purpose of the Study:
- To review the efficacy and safety of IL-1 inhibitors as therapeutic options for recurrent pericarditis.
- To highlight the role of IL-1 pathway inhibition in managing refractory cases of pericarditis.
- To identify remaining questions regarding IL-1 inhibitor therapy in special populations.
Main Methods:
- Review of clinical trial data for IL-1 inhibitors in recurrent pericarditis.
- Analysis of the mechanisms of action for rilonacept, anakinra, and canakinumab.
- Evaluation of safety and efficacy data from relevant studies (RHAPSODY II/III, AIRTRIP, IRAP).
Main Results:
- Rilonacept demonstrated safety and efficacy in treating recurrent pericarditis.
- Anakinra was also found to be safe and efficacious in managing recurrent pericarditis.
- Data on canakinumab use in recurrent pericarditis is limited.
Conclusions:
- IL-1 inhibitors represent a promising therapeutic strategy for recurrent pericarditis, particularly for cases refractory to conventional treatments.
- Further research is needed to establish optimal treatment durations, tapering protocols, and use in special populations like pregnant or lactating women.
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