Key result
IL-1 antagonist anakinra cuts recurrent pericarditis episodes by ~98%.
Why the study?
Recurrent pericarditis remains challenging to manage despite advances, with colchicine as first-line therapy and IL-1 antagonists increasingly used for refractory cases.
Do interleukin-1 antagonists and colchicine reduce recurrence rates in patients with recurrent pericarditis?
Meta-Analysis (n=1,053)
Do interleukin-1 antagonists and colchicine reduce recurrence rates in patients with recurrent pericarditis?
Odds Ratio: 0.02 (95% CI 0.01–0.07)
Interleukin-1 antagonists (anakinra, rilonacept, goflikicept) demonstrate superior efficacy compared to colchicine in reducing recurrent pericarditis episodes, supporting their use as alternative therapies in refractory cases.
IL-1 antagonists outperform colchicine for recurrence prevention in refractory pericarditis; extends network evidence supporting targeted use and guideline refinement.
INTRODUCTION: Despite advancement of therapeutic approaches to recurrent pericarditis, it poses notable challenges to its' management. As per the current guidelines, colchicine is the first line therapy, although, non-conventional treatments like interleukin-1 (IL-1) antagonists (rilonacept, anakinra, goflikicept) are progressively utilized for refractory cases. EVIDENCE ACQUISITION: A comprehensive electronic search identified relevant literature across multiple databases, focusing on recurrence rates and adverse effects associated with each treatment regimen. EVIDENCE SYNTHESIS: Eleven studies (6 on colchicine, 5 on IL-1 antagonists) involving 1053 patients were included. Colchicine significantly reduced recurrence risk by 63% (OR 0.37, 95% CI 0.27-0.52). IL-1 antagonists demonstrated superior efficacy: anakinra reduced recurrence by 98% (OR 0.02, 95% CI 0.01-0.07), rilonacept by 98% (OR 0.02, 95% CI 0.01-0.07), and goflikicept by 99% (OR 0.01, 95% CI 0.00-0.05). Adverse effects were comparable between colchicine and IL-1 antagonists except for rilonacept, which showed a higher risk (OR 5.70, 95% CI 2.13-15.27). CONCLUSIONS: IL-1 antagonists significantly reduce recurrent pericarditis episodes compared to colchicine, with anakinra, rilonacept, and goflikicept demonstrating high efficacy and acceptable safety profiles. These findings support their consideration as alternative therapies in colchicine-refractory cases of recurrent pericarditis. Further studies are warranted to refine treatment guidelines and optimize patient outcomes.
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Desai et al. (2024) conducted a meta-analysis in recurrent pericarditis (n=1,053). IL-1 antagonists (anakinra, rilonacept, goflikicept) vs. colchicine or control was evaluated on recurrence risk (OR 0.02, 95% CI 0.01-0.07). IL-1 antagonists demonstrated superior efficacy in reducing recurrent pericarditis episodes, with anakinra reducing recurrence by 98% (OR 0.02; 95% CI 0.01-0.07).
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