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Anakinra: an emerging option for refractory idiopathic recurrent pericarditis a systematic review of published evidence

Lazaros, George; Imazio, Massimo; Brucato, Antonio; Vassilopoulos, Dimitrios; Vasileiou, Panagiotis; Gattorno, Marco; Tousoulis, Dimitrios; Martini, Alberto

Journal of Cardiovascular Medicine: April 2016 - Volume 17 - Issue 4 - p 256–262
doi: 10.2459/JCM.0000000000000266
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Aims Accumulating evidence suggests idiopathic recurrent pericarditis as a disease of probable autoinflammatory origin, and thus anakinra could be of benefit. The goal of this systematic review was to assess the efficacy and safety of anakinra in this context.

Methods Reports relevant to anakinra administration in patients with idiopathic recurrent pericarditis published up to October 2014 were searched in several databases. All references found, upon initial assessment at title and abstract level for suitability, were consequently retrieved as full reports for further appraisal.

Results Among 12 citations retrieved, nine reports (four case series and five case reports with 34 patients, 20 men, mean age 26.8 years) were assessed. The mean disease duration was 31 months and the number of recurrences 8.2. Anakinra was generally administered as a daily subcutaneous injection of 100 mg or as a mean dose of 1.1 mg/kg/d in weight-adjusted regimens. The mean full-dose duration was 9.2 months. C-reactive protein normalized within 7.1 days, and steroids were withdrawn within 62 days. Dose tapering was adopted in 64.7% of patients, leading to recurrence in 26% of cases. In a 28.3-month follow-up, eight out of 34 patients (23.5%) were disease free without treatment, after having received anakinra for 10.4 months overall. Anakinra was proved well tolerated, with mild local reaction being reported in 44% of patients.

Conclusion Anakinra is a highly effective, rapidly acting, well tolerated and steroid-sparing agent. Recurrences after drug discontinuation are a matter of concern. Randomized trials are required to confirm these findings and address the most effective treatment protocol.

aCardiology Department, Maria Vittoria Hospital and University of Torino, Torino, Italy

bCardiology Department, University of Athens Medical School, Hippokration General Hospital, Athens, Greece

cInternal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy

dDepartment of Medicine and Laboratory, Clinical Immunology and Rheumatology Unit, University of Athens Medical School, Hippokration General Hospital, Athens, Greece

eGiannina Gaslini Institute; Department of Pediatrics, University of Genoa, Genoa, Italy

Correspondence Massimo Imazio, MD, FESC, Cardiology Department, Maria Vittoria Hospital and University of Torino, Via Luigi Cibrario 72, 10141 Turin, Italy Tel: +39 011 4393423; fax: +39 011 4393334; e-mail: massimo_imazio@yahoo.it;massimo.imazio@unito.it

Received 6 October, 2014

Revised 21 November, 2014

Accepted 7 December, 2014

© 2016 Italian Federation of Cardiology. All rights reserved.