Early Introduction and Prolonged Full-Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort.
Malandrino D, Bettiol A, et al. • Journal of the American Heart Association • 2026
Early initiation of anakinra (within 12 months of the first pericarditis episode) and maintenance of full-dose therapy (100 mg/d) 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.
Key Findings
Results
About one in three patients with refractory recurrent pericarditis relapsed after permanently discontinuing anakinra.
Retrospective cohort of 185 consecutive adults with corticosteroid-dependent, colchicine-resistant recurrent pericarditis across 16 international referral centers.
Over a median follow-up of 7.2 months (IQR, 1.5-23.3) after discontinuation, 68 patients (36.8%) experienced recurrence.
Median time to recurrence was 2.1 months (IQR, 0.7-8.5), indicating most relapses occurred early after stopping.
Results
Starting anakinra within 12 months of the first pericarditis episode was independently associated with a lower risk of recurrence after discontinuation.
Patients were treated at 100 mg/d for a median of 6 months (IQR, 4-12) in the cohort.
Results
The cohort consisted mainly of middle-aged women with idiopathic recurrent pericarditis.
58.4% were women, mean age 50.4±17.8 years.
77% had idiopathic cause.
All patients had permanently discontinued anakinra after clinical remission.
Methods
Predictors of post-discontinuation relapse were identified using univariate and multivariable Cox proportional hazards regression and Kaplan-Meier analyses.
Analyses evaluated demographic, clinical, and therapeutic predictors.
The primary end point was pericarditis recurrence after drug discontinuation.
The design was retrospective and multicenter, with a relatively short median post-discontinuation follow-up.
What This Means
This study looked at 185 adults with recurrent pericarditis, a painful inflammation of the sac around the heart that keeps coming back. All had not responded to colchicine and depended on corticosteroids. They were treated with anakinra, an anti-inflammatory drug, and eventually stopped it after their disease went into remission. Researchers at 16 centers in several countries reviewed their records to see who relapsed after stopping.
About 37% (68 patients) had a relapse after stopping, typically within a couple of months (median about 2 months). The risk of relapse was lower in patients who started anakinra within 12 months of their first episode, and in those who stayed on the full 100 mg daily dose for at least 6 months before stopping. The reductions in risk were roughly two-thirds for early start and about half for a longer full-dose course.
This research suggests that earlier use and a sufficiently long course at full dose may be linked to more lasting remission after stopping anakinra. However, the study was retrospective, so it shows associations rather than proof of cause, and follow-up after stopping was fairly short. The findings may help inform discussions between patients and doctors about treatment duration, but they do not replace individual medical guidance.
Malandrino D, Bettiol A, Andreis A, De Ferrari G, Scudeler L, Agosti A, et al.. (2026). Early Introduction and Prolonged Full-Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.050181