Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis

Abstract

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

Heartbeat: improved diagnosis of familial hypercholesterolaemia

“…A meta-analysis by Imazio and colleagues 6 supports the efficacy of antiinterleukin-1 agents, such as anakinra and rilonacept, for prevention of recurrent episodes of pericarditis in patients with corticosteroid-dependent and colchicine-resistant recurrent pericarditis. Anthony and Collier 7 remind us that recurrent pericarditis complicates 15%-30% of index cases of pericarditis; the clinical consequences, in addition to pain, can be serious including recurrent effusions, tamponade physiology and constrictive pericarditis; and there is little data on effective therapies (figure 4).…”

The role of interleukin 1 in the development of human diseases: focus on Anakinra (IL-1 receptor antagonist)

“…Идиопатический рецидивирующий перикардит РКИ [188,189], наблюдательные исследования [190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206], метаанализ [207] Застойная сердечная недостаточность РКИ [208,209], наблюдательные исследования [210][211][212][213] Острый инфаркт миокарда РКИ [214][215][216][217][218][219][220] Миокардит и дилятационная кардиомиопатия Наблюдательные исследования [221][222][223][224] Рефрактерный полисерозит Многоцентровое исследование [225] Заболевания Результаты и комментарии…”

Anti-interleukin-1 agents for pericarditis: a primer for cardiologists

“…If we consider only randomized controlled clinical trials, anti-IL-1 agents have been associated with an increased risk of any adverse events compared to placebo [risk ratio (RR) 5.38, 95% CI 2.08-13.92, I 2 = 0%], including injection site reactions (RR 14.98, 95% CI 2.09-107.09, I 2 = 0%) and infections (RR 3.93, 95% CI 1.33-11.66; Figure 4). 14,16,28 The most common reported side effect is injection site reactions, which occur in the majority of patients treated with anakinra (>50%), 14,17 a significant proportion of those treated with rilonacept (up to 60%), 15,16 and approximately 10% of those treated with canakinumab. [24][25][26][27] Patients receiving anakinra usually report stinging during injection, but injection site reactions usually occur after 1-2 weeks of therapy.…”