Pos1568 anakinra treatment in colchicine resistant pericarditis: a single center experience

Background Recurrent pericarditis (RP) may be encountered in autoinflammatory diseases, such as familial Mediterranean fever (FMF), however, the etiology stands principally unknown [1] . Alternative treatments have been suggested for the treatment of colchicine-resistant cases whether idiopathic or related to FMF [2] . Objectives This study describes our experience of anakinra treatment for colchicine-resistant pericarditis cases. Methods All patients with pericarditis followed in our center who received anakinra since 2014 were evaluated retrospectively. Relevant data were retrieved from archives and verified with telephone interviews. Therapeutic efficacy, as well as the side effect profile, of anakinra was assessed. Results Our series consists of 15 patients (10 males, 5 females) with colchicine-resistant pericarditis whose demographic, clinical, and treatment features are given in Table 1. The mean age was 38.9±15.9. 6 cases were secondary to FMF and the remaining were idiopathic other than one perimyocarditis and one multisystem inflammatory syndrome in adults. Two of all patients whose autoinflammatory genetic panels were screened were detected to carry FMF mutations K695R het. and E148Q. The median follow-up duration was 53 months (range 10-174); the median number of recurrences before anakinra was 4 (range: 1-14). Ten patients (66.7 %) experienced no episode of pericarditis (mean episode count: 0.86) during anakinra treatment. Corticosteroids were discontinued in all patients except one transplant recipient. The anakinra dose of those who progressed attack-free was tapered without relapse in 5 cases, whereas 7 cases relapsed after tapering. Currently, 11 patients carry on anakinra treatment, while 3 patients stopped anakinra since remission was achieved. No side effect of anakinra was observed, with the exception of skin reaction in two patients. Table 1. Demographic features of patients and response to anakinra therapy Patient # Age/ Sex Diagnosis/ Etiology Duration of pericarditis before anakinra treatment (mo) Prior medication(s) Number of recurrences before anakinra Anakinra treatment duration (mo) Time to corticosteroid discontinuation (mo) Recurrences during regular anakinra treatment Current treatment dose 1 56/F FMF 88 CLC, CS 2 13 NA 0 100 mg/day 2 14/F FMF 24 CLC, CS, NSAIDs 5 2 1 3 Switched to canakinumab 3 21/M RPM 36 CLC, CS, NSAIDs 2 3 4 2 100 mg/day 4 77/M IRP 11 CLC, CS 3 42 0 0 100 mg/3-days-in-a-week 5 49/M MIS-A 3 CLC, NSAIDs 4 3 NA 0 Withdrawn-Remission 6 55/M IRP 120 CLC, CS 6 29 0 1 100 mg/day 7 18/M IRP 1 CLC, CS, NSAIDs 1 18 1 0 Remission 8 44/F FMF 14 CLC, NSAIDs 14 23 NA 3 Withdrawn-Remission 9 47/M FMF 3 CLC, CS 3 27 0 4 100 mg/day 10 42/F IRP 10 CLC 6 35 NA 0 100 mg/3-days-in-a-week 11 26/M IRP 77 CLC, CS, Hydroxychloroquine 6 101 1 0 100 mg/day 12 35/F IRP 124 CLC, NSAIDs 4 9 0 Withdrawn-Remission 13 23/M IRP 3 CLC, CS 3 86 2 0 100 mg/2days 14 27/M FMF 15 CLC, CS 5 49 1 0 100 mg/3days 15 23/M FMF 8 CLC, CS 5 29 1 0 *On demand full dose F: Female, M: Male, IRP: Idiopathic recurrent pericarditis, FMF: Familial Mediterranean fever, RPM: Recurrent Perimyocarditis, MIS-A: Multisystem Inflammatory Syndrome in Adults, CLC: colchicine, NSAIDs: Nonsteroidal anti-inflammatory drugs, CS: Corticosteroid, NA: Not applicable *Patient -under colchicine treatment- uses anakinra only in the event of a FMF attack because of injection site skin reactions. Conclusion Anakinra was found to be a safe and effective agent against colchicine-resistant pericarditis, notably recurrent pericarditis. Long-term treatment should be anticipated when initiating treatment and dose tapering should be kept in mind for patients in remission. Relapses should be watched for attentively in tapering and anakinra should be resumed promptly in case of a recurrence. Furthermore, anakinra is important in sparing cortisol treatment. References [1]Imazio, M., Gribaudo, E., & Gaita, F. (2017). Recurrent Pericarditis. Progress in cardiovascular diseases , 59 (4), 360–368. [2]Imazio M. (2021). Clinical Trials in Pericardial Disease: New Paradigm Shift. Current cardiology reports , 23 (11), 170. Acknowledgements None. Disclosure of Interests None Declared.