Efficacy of Anakinra for The Treatment of Recurrent Pericarditis: A Systematic Review

Background: Recurrent and refractory pericarditis can significantly impair quality of life and often responds inadequately to conventional anti-inflammatory therapies. Interleukin-1 blockade with Anakinra has emerged as a potential targeted therapy. We conducted a systematic review to evaluate the efficacy and safety of Anakinra for treating pericarditis. Methods: A comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases was performed from inception through September 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies assessing Anakinra in recurrent pericarditis. Primary outcomes included recurrence rates and symptom resolution, while secondary outcomes evaluated corticosteroid tapering and adverse effects. Results: Eight studies (n = 614 patients) met the inclusion criteria, with sample sizes ranging from 12 to 256 patients and Anakinra doses varying between 1 mg/kg/day to 2 mg/kg/day or a fixed 100 mg/day regimen. Anakinra significantly reduced pericarditis recurrence rates, with some studies reporting up to a six-fold reduction and substantial decreases in emergency department visits (11-fold) and hospitalizations (seven-fold). Symptom resolution was rapid, with most patients achieving complete remission within days, allowing for corticosteroid tapering. No serious adverse events were reported, with transient injection site reactions being the most common side effect (31–38%). Conclusions: Anakinra is an effective and well-tolerated treatment for recurrent pericarditis, particularly in corticosteroid-dependent and colchicine-resistant cases. It significantly reduces recurrence rates, facilitates rapid symptom relief, and minimizes corticosteroid use. While no serious adverse events were observed, long-term safety data remain limited. Future large-scale, placebo-controlled trials are needed to establish the optimal dosing regimen and long-term risk-benefit profile of Anakinra in recurrent pericarditis management.