Anakinra achieves 95% remission and cuts recurrences in refractory recurrent pericarditis patients

Recurrent pericarditis (RP) is a debilitating inflammatory condition often requiring long-term glucocorticoid (GC) therapy, which carries significant side effects. Many patients become refractory to conventional treatments or dependent on GCs, highlighting an unmet need for effective, steroid-sparing alternatives. Interleukin-1 (IL-1) plays a central role in the pathogenesis of pericarditis, making IL-1 antagonists like anakinra a targeted therapeutic strategy to disrupt the inflammatory cascade and manage chronic inflammation.

This retrospective study evaluated the long-term efficacy and safety of anakinra in 20 patients (median age 50 years at onset, 14 males, 6 females) with refractory or GC-dependent recurrent pericarditis. Patients had a median disease duration of 48 months and 4 prior recurrences. Anakinra was initiated after a median of 11.5 months from the first acute pericarditis episode. 16 patients were on GCs (mean prednisolone dose 17.7 mg) at initiation. The primary outcome was any recurrence ('flare') after anakinra initiation, assessed via medical record review.

Anakinra demonstrated high effectiveness, with 19/20 patients achieving remission. The annualized recurrence rates significantly decreased after anakinra initiation, dropping from a median of 5.33 (IQR 4.68) recurrences pre-treatment to 0 (IQR 0.26) post-treatment. This substantial reduction highlights anakinra's ability to control disease activity. Furthermore, 12 patients successfully achieved glucocorticoid withdrawal, while 4 remained on a low-dose prednisolone (mean dose 3 mg).