Efficacy and safety of Anakinra in idiopathic recurrent pericarditis: Results from the UPACITER study

Idiopathic recurrent pericarditis (IRP) is a chronic autoinflammatory condition characterized by relapsing episodes of pericardial inflammation. Standard treatment involves colchicine and non-steroidal anti-inflammatory drugs (NSAIDs), with corticosteroids as a second-line therapy. However, many patients develop corticosteroid dependency or resistance, necessitating alternative treatments. Anakinra, an interleukin-1 (IL-1) receptor antagonist, has shown promising results as a third-line therapy.

The UPACITER multicenter study is a retrospective study conducted on patients with IRP and treated with anakinra between 2018 and 2024 in Midi-Pyrénées region of France. Patients met the 2015 ESC criteria for recurrent pericarditis. Clinical features, treatment responses, and side effects were collected. Primary endpoint was complete response, defined as the resolution of symptoms, normalization of C-reactive protein levels, and absence of pericardial effusion.

Twelve patients were included, with a median age of 46 years (interquartile range: 29.7-52.7). All patients achieved a complete response and corticosteroid discontinuation (from 17.9 ± 10.68 mg to 0 mg, p < 0.005). The recurrence-free survival rates were 100 % (95 % CI [100;100]) at month 6, 88.9 % (95 % CI [70.6;100]) at month 12, and 77.8 % (95 % CI [54.9;100]) at months 18 and 24. Three patients experienced a relapse of pericarditis: 2 during the spacing of injection and one after discontinuation of anakinra, with a median time before relapse of 12 months (IQR 9.5-13). One serious infection was reported.

Anakinra is a safe and effective third-line therapy for patients with IRP resistant to conventional treatments, leading to a reduction in recurrences and corticosteroid discontinuation.