Efficacy of colchicine in addition to anakinra in patients with recurrent pericarditis
Allan L Klein,
Antonio Abbate,
Massimo Imazio,
George Lazaros,
Antonio Brucato,
Luca Cantarini,
Marco Merlo,
Gianfranco Sinagra,
Alessandro Andreis,
Valentino Collini,
Maria De Martino,
Marzia De Biasio,
Miriam Isola,
Nicole Croatto,
Veronica Lepre
Affiliations
Allan L Klein
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Antonio Abbate
Virginia Commonwealth University, Richmond, Virginia, USA
Massimo Imazio
Cardiology and Cardiothoracic Department Department of Medicine, University of Udine, Udine, Italy
George Lazaros
Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
Antonio Brucato
Department of Biomedical and Clinical Sciences Sacco, University of Milano, Milano, Italy
Luca Cantarini
University of Siena, Siena, Italy
Marco Merlo
Cardiology Specialty School, University of Trieste, Trieste, Italy
Gianfranco Sinagra
Cardiology Specialty School, University of Trieste, Trieste, Italy
Alessandro Andreis
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, University of Torino, Torino, Italy
Valentino Collini
Cardiology and Cardiothoracic Department Department of Medicine, University of Udine, Udine, Italy
Maria De Martino
Department of Medicine (DMED), University of Udine, Udine, Italy
Marzia De Biasio
Cardiology and Cardiothoracic Department Department of Medicine, University of Udine, Udine, Italy
Miriam Isola
Department of Medicine (DMED), University of Udine, Udine, Italy
Nicole Croatto
Department of Medicine (DMED), University of Udine, Udine, Italy
Veronica Lepre
Cardiology Specialty School, University of Trieste, Trieste, Italy
Aim Anakinra, an anti IL-1 agent targeting IL-1 alfa and beta, is available for the treatment of recurrent pericarditis in cases with corticosteroid dependence and colchicine resistance after failure of conventional therapies. However, it is unclear if the combination with colchicine, a non-specific inhibitor of the inflammasome targeting the same inflammatory pathway of IL-1, could provide additional benefit to prevent further recurrences. The aim of the present observational study is to assess whether the addition of colchicine on top of anakinra could prolong the time to first recurrence and prevent recurrences better than anakinra alone.Methods International, all-comers, multicentre, retrospective observational cohort study analysing all consecutive patients treated with anakinra for corticosteroid-dependent and colchicine-resistant recurrent pericarditis. The efficacy endpoint was recurrence rate and the time to the first recurrence.Results A total of 256 patients (mean age 45.0±15.4 years, 65.6% females, 80.9% with idiopathic/viral aetiology) were included. 64 (25.0%) were treated with anakinra as monotherapy while 192 (75.0%) with both anakinra and colchicine. After a follow-up of 12 months, 56 (21.9%) patients had recurrences. Patients treated with colchicine added to anakinra had a lower incidence of recurrences (respectively, 18.8% vs 31.3%; p=0.036) and a longer event-free survival (p=0.025). In multivariable analysis, colchicine use prevented recurrences (HR 0.52, 95% CI 0.29 to 0.91; p=0.021).Conclusions The addition of colchicine on top of anakinra treatment could be helpful to reduce recurrences and prolong the recurrence-free survival.
