Anakinra in idiopathic recurrent pericarditis refractory to immunosuppressive therapy; a preliminary experience in seven patients.
Autoimmun Rev
; 18(6): 627-631, 2019 Jun.
Article
em En
| MEDLINE
| ID: mdl-30959216
ABSTRACT
BACKGROUND:
Approximately 5% of idiopathic recurrent pericarditis (IRP) patients are refractory or intolerant to NSAIDs, Colchicine and corticosteroids. The empiric treatment approach for these patients includes immunosuppression with Azathioprine (AZA) or immunomodulation with intravenous human immunoglobulin (IVIG). We assessed the efficacy and safety of long-term Anakinra treatment in refractory IRP patients after failure of prior immunosuppressive therapy and/or failure of IVIG.METHODS:
Clinical data of seven IRP patients were retrospectively analyzed. Treatment efficacy was determined by decrease of IRP recurrence and by the ability to withdraw or taper corticosteroids without a relapse. Safety was assessed by the occurrence of adverse events.RESULTS:
7 IRP patients (4 male, median age 41) with a median disease duration of 4â¯years (range 1.25-9â¯years) were treated with Anakinra (median treatment duration 20â¯months). All patients were resistant or intolerant to NSAIDs, Prednisone, Colchicine and at least one immunosuppressive or immunomodulatory drug such as AZA, Methotrexate, Plaquenil, or IVIG. The median number of recurrences before Anakinra was 6 (range 4-7) and all patients were corticosteroid-dependent and had steroid-related side effects. After initiation of Anakinra, none of the patients had IRP relapse. Prednisone was tapered down to 5â¯mg/day or less in all patients. Four patients discontinued prednisone altogether. No significant adverse effects have occurred as a result of Anakinra treatment and all patients continued treatment after the study period.CONCLUSION:
Long-term Anakinra is a rapid-acting, efficient and safe steroid sparing agent even for patients with IRP refractory to previous immunosuppressive and/or immunomodulatory agents.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Pericardite
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Antirreumáticos
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Proteína Antagonista do Receptor de Interleucina 1
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article