COVID‐19 Disease in Patients With Recurrent Pericarditis During Treatment With Anakinra: Comment on the Article by Navarro‐Millán et al

To the Editor: We read with interest the article by Dr. Navarro-Millán and colleagues about the use of anakinra to prevent mechanical ventilation in patients with COVID-19 (1). However, it is also important to consider patients who develop COVID-19 while being treated with anakinra for their underlying condition (2). We describe 5 patients, median age 43 years, with recurrent pericarditis (post-pericardiotomy in 1 case; idiopathic pericarditis in 4 cases) who developed COVID-19 disease during treatment with anakinra. Median duration of recurrent pericarditis was 48 months. All patients were being treated with anakinra when COVID-19 disease occurred, after having initially received treatment with glucocorticoids and/or nonsteroidal antiinflammatory drugs (including colchicine) (Table 1). The patients developed COVID-19 disease between March 2020 and October 2020. Symptoms, usually mild, included fever, cough, ageusia, anosmia, headache, diarrhea, dyspnea, and chest pain (Table 1). SARS–CoV-2 was diagnosed by nasopharyngeal swab in 4 patients, and by serologic test in 1 patient, after symptoms began. Two patients went to the emergency room; in one case, chest radiograph showed a small lung infiltrate, but neither of the patients required hospitalization. Treatment with anakinra was continued unchanged, and 3 patients received additional therapies after the development of COVID-19 disease (Table 1). All patients recovered completely within 15 days and had no recurrence of pericarditis. Polytherapy is often necessary in patients with recurrent pericarditis and treatment with an interleukin-1 receptor antagonist may lead to resolution of symptoms (3); however, a concern may be raised that biologic therapy could aggravate the clinical course of COVID-19. Our small case series shows that anakinra therapy in patients with recurrent pericarditis may be associated with a benign clinical course. We propose that there is no reason to discontinue anakinra therapy if a patient with recurrent pericarditis develops COVID-19 disease (4-7). Our recommendation is consistent with the findings obtained in the study by Dr. Navarro-Millán et al (1). Dr. Brucato has received research support from Sobi and Acarpia. Dr. Imazio has received consulting fees or honoraria from Kiniksa and Sobi (less than $10,000 each).