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

Imazio, Massimo
Andreis, Alessandro
Piroli, Francesco
Lazaros, George
Gattorno, Marco
Lewinter, Martin
Klein, Allan L
Brucato, Antonio

¹University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy,
²Department of Public Health and Pediatrics, University of Turin, Torino, Italy,
³Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy,
⁴Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece,
⁵Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Giannina Gaslini, Genova, Liguria, Italy,
⁶Larner College of Medicine, University of Vermont, Burlington, Vermont, USA,
⁷Department 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,
⁸Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, University of Milan, Milano, Italy,

Correspondence to Professor Massimo Imazio, University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; e-mail; [email protected]

Received December 19, 2020; revision received February 03, 2021; Accepted March 01, 2021; previously published online March 18, 2021

Heart 107(15):p 1240-1245, August 2021. | DOI: 10.1136/heartjnl-2020-318869

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.