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The Use of IL-1 Receptor Antagonist (Anakinra) in Idiopathic Recurrent Pericarditis: a Narrative Review


Affiliations
1 The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States
2 Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
3 Section of Pediatric Rheumatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
 

Recurrent pericarditis is a complication of acute pericarditis in 20-30% of the patients and is usually idiopathic in nature. The underlying pathogenesis of this condition remains unclear, although immune-mediated mechanisms seem likely. A subgroup of these patients with refractory symptoms can be challenging to manage, and multiple immunosuppressive medications have been used without consistent benefit. Anakinra, an interleukin-1 receptor antagonist, has been used in treatment of rheumatoid arthritis and autoinflammatory syndromes. Preliminary evidence suggests that anakinra could be a promising therapy for idiopathic recurrent pericarditis. In this narrative review, we summarize the current understanding of the etiopathogenesis of idiopathic recurrent pericarditis, mechanism of action of anakinra, and the preliminary evidence, supporting the use of anakinra in pericarditis.
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  • The Use of IL-1 Receptor Antagonist (Anakinra) in Idiopathic Recurrent Pericarditis: a Narrative Review

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Authors

Shankar Baskar
The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States
Allan L. Klein
Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
Andrew Zeft
Section of Pediatric Rheumatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States

Abstract


Recurrent pericarditis is a complication of acute pericarditis in 20-30% of the patients and is usually idiopathic in nature. The underlying pathogenesis of this condition remains unclear, although immune-mediated mechanisms seem likely. A subgroup of these patients with refractory symptoms can be challenging to manage, and multiple immunosuppressive medications have been used without consistent benefit. Anakinra, an interleukin-1 receptor antagonist, has been used in treatment of rheumatoid arthritis and autoinflammatory syndromes. Preliminary evidence suggests that anakinra could be a promising therapy for idiopathic recurrent pericarditis. In this narrative review, we summarize the current understanding of the etiopathogenesis of idiopathic recurrent pericarditis, mechanism of action of anakinra, and the preliminary evidence, supporting the use of anakinra in pericarditis.