Background Resistant – recurring pericarditis (RRP) is often associated with autoinflammatory syndromes. Conventional therapy with glucocorticoids and colchicine is often enough unsuccessful, thus nowadays the use of anakinra in such cases is becoming common every – day practice.
Objectives Our goal was to determine whether RRP was associated with gene mutations relevant with autoinflammatory diseases and then compare the effectiveness of canakimumab and anakinra.
Methods We studied 18 patients with RRP (all women, from 14 to 36 years old) determing the existence of mutation from the infevers database (25 genes, from MEFV and TNFRSF1A to MVK and SLC 29A3, all related with autoinflammatory diseases). All the patients were proven positive to one of the above mutations (all heterozygous) and then treatment with anakinra (n=9, 100mg sc once daily) and canakimumab (n=9, 150mg sc q4wk) was administered.
Results During the study (3 years), all anakinra patients stopped receiving per os glucocorticoids and were free of any new pericarditis episodes. 3 of them (33%) stopped any treatment after a year of anakinra therapy and none was presented with any skin reactions.
On the contrary, all canakimumab patients were not able to free themselves of the glucocorticoid treatment, since at least one new episode of pericarditis to each patient was recorded. Two of them were free of pericarditis the last year of the study (though being treated with 2,5mg prednisolone per os daily).
Statistically speaking, the use of IL-1R antagonist in recurrent – resistant pericarditis associated with autoinflammatory mutations was proven much more successful (p<0,01) than the use of the IL-1b Mab.
Conclusions Though the sample of patients (n=18) was too small in order to set us able to reach any safe conclusions, it is quite possible that anakinra may be one effective solution that can prevent the long term administration of corticoids to patients with recurrent pericarditis Canakimumab was not recorded with similar positive results.
Disclosure of Interest None declared
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