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Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis
  1. Massimo Imazio1,2,
  2. Alessandro Andreis3,
  3. Francesco Piroli3,
  4. George Lazaros4,
  5. Marco Gattorno5,
  6. Martin Lewinter6,
  7. Allan L Klein7,
  8. Antonio Brucato8
  1. 1 University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  2. 2 Department of Public Health and Pediatrics, University of Turin, Torino, Italy
  3. 3 Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
  4. 4 Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
  5. 5 Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Giannina Gaslini, Genova, Liguria, Italy
  6. 6 Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
  7. 7 Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
  8. 8 Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, University of Milan, Milano, Italy
  1. Correspondence to Professor Massimo Imazio, University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; massimo_imazio{at}yahoo.it

Abstract

Aims Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition. This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.

Methods We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.

Results The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.

Conclusions In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.

  • pericarditis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/heartjnl-2020-318869

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors All authors contributed to the planning, conduct, drafting and reporting of the work. The manuscript was revised and approved by all authors. MI, AA and FP are responsible for the overall content as guarantors.

    • 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 MI, MG, ML, ALK and AB have been Advisory Board members for KINIKSA and SOBI.

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

    • Author note Additional references w1–4 can be found in online supplemental file 2.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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