Anti-
interleukin (IL)-1 agents have been developed for the treatment of autoinflammatory diseases characterized by overproduction of
IL-1. Idiopathic recurrent
pericarditis with inflammatory phenotype (
fever,
leukocytosis, and elevation of
C-reactive protein) has similar features and responds well to this treatment. At present, in Italy, prescription of
anakinra is possible for idiopathic recurrent
pericarditis with
corticosteroid dependence and
colchicine resistance.
Anakinra is a recombinant antagonist of
IL-1 receptor and blocks either IL-1α (released from pericardial cells) or IL-1β (derived for inflammatory cells, during
pericarditis).
Anakinra is prescribed at the dose of 2 mg/kg/day subcutaneously up to 100 mg/day subcutaneously for at least 3 to 6 months with subsequent tapering.
Anakinra allows a quick control of symptoms after 1-2 doses and a fast and safe tapering and withdrawal of
corticosteroids.
Colchicine can be used together with
anakinra. The most common side effect is represented by local skin
injection site reactions after 1-2 weeks of
therapy. These reactions are usually transient and can be treated by anti-histamines and topical
corticosteroids. Less common side effects include elevation of
transaminases (4-5%), cutaneous or
respiratory infections (2-3%), and
leukopenia (1-3%). Side effects are rarely responsible for permanent discontinuation of
therapy. The aim of the present review is to provide a practical guide on the use of these drugs for cardiologists, who are often not familial with this new
therapy for
pericarditis.