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Publications

Journal Article Multicenter Study Ppublish

PubMed: 42885757 DOI: 10.1161/JAHA.126.050181

Early Introduction and Prolonged Full-Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort.

J Am Heart Assoc 15(20):e050181

Authors: Danilo Malandrino, Alessandra Bettiol, Alessandro Andreis, Gaetano M De Ferrari, Luca Scudeler, Alessandra Agosti, Alida L P Caforio, Maria Canfora, Luca Cantarini, Andreja C Cercek, Lorenzo Dagna, Antonella Insalaco, Marco Gattorno, Roberta Caorsi, Allan Klein, George Lazaros, Giuseppe Lopalco, Sushil A Luis, Silvia Maestroni, Irene Mattioli, Raffaele Manna, Vartan Mardigyan, Gabriele Simonini, Elena Silvestri, Antonio Tavoni, Massimo Imazio, Antonio Brucato, Giacomo Emmi

Affiliations

  • Department of Experimental and Clinical Medicine University of Florence Florence Italy.
  • Department of Experimental and Clinical Biomedical Sciences "Mario Serio" University of Florence Florence Italy.
  • University Cardiology, AOU Città della Salute e della Scienza di Torino Turin Italy.
  • Advanced Cardiovascular Echocardiography Unit, Cardiovascular and Thoracic Department AOU Città della Salute e della Scienza di Torino Turin Italy.
  • Cardiology and Cardioimmunology Laboratory, Department of Cardiac Thoracic Vascular Sciences and Public Health University of Padua Padua Italy.
  • Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences University of Siena Siena Italy.
  • Department of Cardiology University Medical Center Ljubljana Ljubljana Slovenia.
  • Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan Italy and Vita-Salute San Raffaele University Milan Italy.
  • Rheumatology Unit Ospedale Pediatrico Bambino Gesù IRCCS, ERN-RITA Center Rome Italy.
  • Rheumatology and Autoinflammatory diseases IRCCS Istituto Giannina Gaslini Genoa Italy.
  • Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA.
  • First Cardiology Department National and Kapodistrian University of Athens School of Medicine Athens Greece.
  • Rheumatology Unit, Department of Precision and Regenerative Medicine, Jonian Area (DiPReMeJ) University of Bari "Aldo Moro" Bari Italy.
  • Department of Cardiothoracic Surgery Mayo Clinic Rochester MN USA.
  • Papa Giovanni XXIII Hospital Bergamo Italy.
  • Periodic Fever Research and Rare Disease Center Università Cattolica Sacro Cuore Rome Italy.
  • Division of Cardiology Jewish General Hospital Montréal Canada.
  • Rheumatology Unit, ERN ReCONNET Center Meyer Children's Hospital IRCCS Florence Italy.
  • Clinical Immunology Unit, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy.
  • Cardiothoracic Department, University Hospital Santa Maria Della Misericordia ASUFC, Piazzale Santa Maria della Misericordia Udine Italy.
  • Department of Medicine (DMED) University of Udine Udine Italy.
  • Internal Medicine, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences University of Milan Milan Italy.
  • Centre Hospitalier Universitaire Vaudois Immunology and Allergy Service, University of Lausanne Lausanne Switzerland.
  • Department of Medical Surgical and Health Sciences, University of Trieste Trieste Italy.
  • Centre for Inflammatory Diseases Department of Medicine, Monash University, Monash Medical Centre Melbourne Australia.

Abstract

BACKGROUND

Anakinra is effective in recurrent pericarditis, yet optimal treatment duration and strategies for safe drug discontinuation remain uncertain. Identifying predictors of sustained remission after discontinuation is important for clinical management.

METHODS

We retrospectively analyzed 185 consecutive adult patients with corticosteroid-dependent and colchicine-resistant refractory recurrent pericarditis across 16 international referral centers, who permanently discontinued therapy after clinical remission. The primary end point was pericarditis recurrence after drug discontinuation. Univariate and multivariable Cox proportional hazards regression and Kaplan-Meier analyses were performed to identify demographic, clinical, and therapeutic predictors of postdiscontinuation relapse.

RESULTS

Among 185 patients who discontinued anakinra (58.4% women, mean age 50.4±17.8 years, 77% idiopathic cause), treatment was initiated a median of 10 months (interquartile range [IQR], 4.0-19.5) after the first episode and continued at 100 mg/d for a median of 6 months (IQR, 4-12). Over a median follow-up of 7.2 months (IQR, 1.5-23.3) after discontinuation, 68 patients (36.8%) experienced recurrence, with a median time to recurrence of 2.1 months (IQR, 0.7-8.5). Initiation within 12 months from the first pericarditis episode and maintenance of full-dose therapy (100 mg/d) for ≥6 months were independently associated with lower recurrence risk (hazard ratio [HR], 0.33 [95% CI, 0.18-0.66]; P=0.001 and HR, 0.48 [95% CI, 0.23-0.86]; P=0.017; respectively).

CONCLUSIONS

Early initiation of anakinra and maintenance of full-dose therapy for at least 6 months are associated with a significantly lower risk of relapse after discontinuation and may inform treatment duration and discontinuation strategies in recurrent pericarditis.

MeSH

Heart Diseases, Pharmaceutical Preparations, Duration Of Therapy, Pericarditis, Maintenance, Therapeutics