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Original research
Anakinra for constrictive pericarditis associated with incessant or recurrent pericarditis
  1. Alessandro Andreis1,
  2. Massimo Imazio2,3,
  3. Carla Giustetto4,
  4. Antonio Brucato5,
  5. Yehuda Adler6,
  6. Gaetano Maria De Ferrari7
  1. 1 University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
  2. 2 University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  3. 3 Department of Public Health and Pediatrics, University of Torino, Torino, Italy
  4. 4 University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino and University of Torino, Torino, Italy
  5. 5 Department of Medicine, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco and Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy
  6. 6 Dean for Medical Professions, College of Law and Business, Ramat Gan.Sackler Faculty of Medicine, Tel Aviv University, Mayanei Hayeshua. Medical Center, Bnei Brak, Tel Aviv, Israel
  7. 7 University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino and University of Torino, Torino, Piemonte, Italy
  1. Correspondence to Professor Massimo Imazio, University Cardiology, AOU Città della Salute e della Scienza di Torino and University of Torino, Torino, Italy; massimo_imazio{at}yahoo.it

Abstract

Objective Frequent flares of pericardial inflammation in recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance may represent a risk factor for constrictive pericarditis (CP). This study was aimed at the identification of CP in these patients, evaluating the efficacy and safety of anakinra, a third-line treatment based on interleukin-1 inhibition, to treat CP and prevent the need for pericardiectomy.

Methods Consecutive patients with recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance were included in a prospective cohort study from 2015 to 2018. Enrolled patients received anakinra 100 mg once daily subcutaneously. The primary end point was the occurrence of CP. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months.

Results Thirty-nine patients (mean age 42 years, 67% females) were assessed, with a baseline recurrence rate of 2.76 flares/patient-year and a median disease duration of 12 months (IQR 9–20). During follow-up, CP was diagnosed in 8/39 (20%) patients. After anakinra dose of 100 mg/day, 5 patients (63%) had a complete resolution of pericardial constriction within a median of 1.2 months (IQR 1–4). In other three patients (37%), CP became chronic, requiring pericardiectomy within a median of 2.8 months (IQR 2–5). CP occurred in 11 patients (28%) with incessant course, which was associated with an increased risk of CP over time (HR for CP 30.6, 95% CI 3.69 to 253.09).

Conclusions In patients with recurrent or incessant pericarditis, anakinra may have a role in CP reversal. The risk of CP is associated with incessant rather than recurrent course.

  • pericardial constriction

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Footnotes

  • AA and MI contributed equally.

  • To be presented at ESC Congress 2020 under Young Investigation Award- Best Poster To be presented at ESC Congress 2020 under Young Investigation Award- Best Poster

  • Contributors AA: study design and conception, data collection, interpretation and analysis, article drafting, critical revision and approval of the final version, responsible for the overall content as guarantor. MMI: study design and conception, data collection, interpretation and analysis, article drafting, critical revision and approval of the final version, responsible for the overall content as guarantor. CG: critical revision and approval of the final version. AB: critical revision and approval of the final version. YA: critical revision and approval of the final version. GMDF: critical revision and approval of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee and all patients provided written informed consent. Protocol data were collected in accordance with the institutional review board policies and complied with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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