Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort

Background Anakinra is effective in recurrent pericarditis, yet optimal treatment duration and strategies for safe drug discontinuation remain uncertain. Identifying predictors of sustained remission after discontinuation is important for clinical management. Methods We retrospectively analyzed 185 consecutive adult patients with corticosteroid‐dependent and colchicine‐resistant refractory recurrent pericarditis across 16 international referral centers, who permanently discontinued therapy after clinical remission. The primary end point was pericarditis recurrence after drug discontinuation. Univariate and multivariable Cox proportional hazards regression and Kaplan‐Meier analyses were performed to identify demographic, clinical, and therapeutic predictors of postdiscontinuation relapse. Results Among 185 patients who discontinued anakinra (58.4% women, mean age 50.4±17.8 years, 77% idiopathic cause), treatment was initiated a median of 10 months (interquartile range [IQR], 4.0–19.5) after the first episode and continued at 100 mg/d for a median of 6 months (IQR, 4–12). Over a median follow‐up of 7.2 months (IQR, 1.5–23.3) after discontinuation, 68 patients (36.8%) experienced recurrence, with a median time to recurrence of 2.1 months (IQR, 0.7–8.5). Initiation within 12 months from the first pericarditis episode and maintenance of full‐dose therapy (100 mg/d) for ≥6 months were independently associated with lower recurrence risk (hazard ratio [HR], 0.33 [95% CI, 0.18–0.66]; P =0.001 and HR, 0.48 [95% CI, 0.23–0.86]; P =0.017; respectively). Conclusions Early initiation of anakinra and maintenance of full‐dose therapy for at least 6 months are associated with a significantly lower risk of relapse after discontinuation and may inform treatment duration and discontinuation strategies in recurrent pericarditis.

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Journal
Journal of the American Heart Association
Published
2026-10-16
DOI
https://doi.org/10.1161/jaha.126.050181
Primary Topic
Pericarditis and Cardiac Tamponade
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article
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article

Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort

Vartan Mardigyan, Antonio Luca Brucato, Andrea Silvio Giordani, Danilo Malandrino et al.
Journal of the American Heart Association
Pericarditis and Cardiac Tamponade
article

Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort

Vartan Mardigyan, Antonio Luca Brucato, Andrea Silvio Giordani, Danilo Malandrino, Gabriele Simonini, Giuseppe Lopalco, Lorenzo Dagna, Irene Mattioli, Alessandro De Matteis, Silvia Maestroni, Elena Silvestri, George A. Lazaros, Roberta Caorsi, Sushil Allen Luis, Allan L. Klein, Alessandra Bettiol, Alessandro Andreis, Massimo Imazio, Alida L.P. Caforio, Luca Cantarini, Gaetano Maria De Ferrari, Maria Canfora, Ludovico Luca Sicignano, Giacomo Emmi, Marco Gattorno, Alessandra Agosti, Emilia Lazarou, Antonella Insalaco, Raffaele Manna, Antonio Gaetano Tavoni, Luca Scudeler, Anna Baritussio, Andreja C. Cercek, Fabrizio De Benedetti
article en

Abstract

Background Anakinra is effective in recurrent pericarditis, yet optimal treatment duration and strategies for safe drug discontinuation remain uncertain. Identifying predictors of sustained remission after discontinuation is important for clinical management. Methods We retrospectively analyzed 185 consecutive adult patients with corticosteroid‐dependent and colchicine‐resistant refractory recurrent pericarditis across 16 international referral centers, who permanently discontinued therapy after clinical remission. The primary end point was pericarditis recurrence after drug discontinuation. Univariate and multivariable Cox proportional hazards regression and Kaplan‐Meier analyses were performed to identify demographic, clinical, and therapeutic predictors of postdiscontinuation relapse. Results Among 185 patients who discontinued anakinra (58.4% women, mean age 50.4±17.8 years, 77% idiopathic cause), treatment was initiated a median of 10 months (interquartile range [IQR], 4.0–19.5) after the first episode and continued at 100 mg/d for a median of 6 months (IQR, 4–12). Over a median follow‐up of 7.2 months (IQR, 1.5–23.3) after discontinuation, 68 patients (36.8%) experienced recurrence, with a median time to recurrence of 2.1 months (IQR, 0.7–8.5). Initiation within 12 months from the first pericarditis episode and maintenance of full‐dose therapy (100 mg/d) for ≥6 months were independently associated with lower recurrence risk (hazard ratio [HR], 0.33 [95% CI, 0.18–0.66]; P =0.001 and HR, 0.48 [95% CI, 0.23–0.86]; P =0.017; respectively). Conclusions Early initiation of anakinra and maintenance of full‐dose therapy for at least 6 months are associated with a significantly lower risk of relapse after discontinuation and may inform treatment duration and discontinuation strategies in recurrent pericarditis.

Journal of the American Heart Association
University of Siena (IT), Università Cattolica del Sacro Cuore (IT), University of Pisa (IT), University of Udine (IT), Cleveland Clinic (US), Mayo Clinic (US), University of Padua (IT), University of Trieste (IT), Vita-Salute San Raffaele University (IT), University of Milan (IT), National and Kapodistrian University of Athens (GR), Ljubljana University Medical Centre (SI), Monash Medical Centre (AU), Istituto Giannina Gaslini (IT), Jewish General Hospital (CA), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Papa Giovanni XXIII (IT), Meyer Children's Hospital (IT), Ospedale Santa Maria (IT), Bambino Gesù Children's Hospital (IT), University of Florence (IT), University of Bari Aldo Moro (IT), Misericordia University (US), University of Lausanne (CH)
Good health and well-being
Openalex Percentile: Top 12%
Pericarditis and Cardiac Tamponade
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