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Peer-reviewedCC BY-NC-NDJournal of the American Heart Association

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

  • Danilo Malandrino1
  • Alessandra Bettiol1
  • Alessandro Andreis2,3
  • Gaetano M. De Ferrari2
  • Luca Scudeler2
  • Alessandra Agosti2
  • Alida L. P. Caforio4
  • Maria Canfora1
  • Luca Cantarini5
  • Andreja C. Cercek6
  • Lorenzo Dagna7
  • Antonella Insalaco8
22 more authors
  • Marco Gattorno9
  • Roberta Caorsi9
  • Allan Klein10
  • George Lazaros11
  • Giuseppe Lopalco12
  • Sushil A. Luis13
  • Silvia Maestroni14
  • Irene Mattioli1
  • Raffaele Manna15
  • Vartan Mardigyan16
  • Gabriele Simonini17
  • Elena Silvestri1
  • Antonio Tavoni18
  • Massimo Imazio19,20
  • Antonio Brucato21
  • Giacomo Emmi22,23,24
  • Fabrizio De Benedetti
  • Emilia Lazarou
  • Ludovico Luca Sicignano
  • Alessandro De Matteis
  • Anna Baritussio
  • Andrea Silvio Giordani
24 affiliations
  1. 1University of Florence
  2. 2University Cardiology, AOU Città della Salute e della Scienza di Torino
  3. 3AOU Città della Salute e della Scienza di Torino
  4. 4University of Padua
  5. 5University of Siena
  6. 6University Medical Center Ljubljana
  7. 7Italy and Vita‐Salute San Raffaele University
  8. 8Ospedale Pediatrico Bambino Gesù IRCCS, ERN‐RITA Center
  9. 9IRCCS Istituto Giannina Gaslini
  10. 10Cleveland Clinic
  11. 11National and Kapodistrian University of Athens School of Medicine
  12. 12University of Bari “Aldo Moro”
  13. 13Mayo Clinic
  14. 14Papa Giovanni XXIII Hospital
  15. 15Università Cattolica Sacro Cuore
  16. 16Jewish General Hospital
  17. 17Meyer Children's Hospital IRCCS
  18. 18University of Pisa
  19. 19ASUFC, Piazzale Santa Maria della Misericordia
  20. 20University of Udine
  21. 21University of Milan
  22. 22Immunology and Allergy Service, University of Lausanne
  23. 23Surgical and Health Sciences, University of Trieste
  24. 24Department of Medicine, Monash University, Monash Medical Centre
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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.

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Cite

BibTeXRIS
BibTeX
@article{malandrino2026early,
  title = {{Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort}},
  author = {Danilo Malandrino and Alessandra Bettiol and Alessandro Andreis and Gaetano M. De Ferrari and Luca Scudeler and Alessandra Agosti and Alida L. P. Caforio and Maria Canfora and Luca Cantarini and Andreja C. Cercek and Lorenzo Dagna and Antonella Insalaco and Marco Gattorno and Roberta Caorsi and Allan Klein and George Lazaros and Giuseppe Lopalco and Sushil A. Luis and Silvia Maestroni and Irene Mattioli and Raffaele Manna and Vartan Mardigyan and Gabriele Simonini and Elena Silvestri and Antonio Tavoni and Massimo Imazio and Antonio Brucato and Giacomo Emmi and Fabrizio De Benedetti and Emilia Lazarou and Ludovico Luca Sicignano and Alessandro De Matteis and Anna Baritussio and Andrea Silvio Giordani},
  journal = {Journal of the American Heart Association},
  year = {2026},
  month = oct,
  doi = {10.1161/jaha.126.050181},
  url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.050181},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort
AU  - Danilo Malandrino
AU  - Alessandra Bettiol
AU  - Alessandro Andreis
AU  - Gaetano M. De Ferrari
AU  - Luca Scudeler
AU  - Alessandra Agosti
AU  - Alida L. P. Caforio
AU  - Maria Canfora
AU  - Luca Cantarini
AU  - Andreja C. Cercek
AU  - Lorenzo Dagna
AU  - Antonella Insalaco
AU  - Marco Gattorno
AU  - Roberta Caorsi
AU  - Allan Klein
AU  - George Lazaros
AU  - Giuseppe Lopalco
AU  - Sushil A. Luis
AU  - Silvia Maestroni
AU  - Irene Mattioli
AU  - Raffaele Manna
AU  - Vartan Mardigyan
AU  - Gabriele Simonini
AU  - Elena Silvestri
AU  - Antonio Tavoni
AU  - Massimo Imazio
AU  - Antonio Brucato
AU  - Giacomo Emmi
AU  - Fabrizio De Benedetti
AU  - Emilia Lazarou
AU  - Ludovico Luca Sicignano
AU  - Alessandro De Matteis
AU  - Anna Baritussio
AU  - Andrea Silvio Giordani
PY  - 2026
DA  - 2026/10/20
JO  - Journal of the American Heart Association
DO  - 10.1161/jaha.126.050181
UR  - https://www.ahajournals.org/doi/10.1161/JAHA.126.050181
AB  - 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.
SN  - 2047-9980
ER  -