ACUTE AND LONG-TERM EFFICACY OF IL-1 INHIBITOR ANAKINRA IN IDIOPATHIC AND SECONDARY PERICARDITIS IN PATIENTS REFRACTORY OR INTOLERANT TO CONVENTIONAL THERAPY

Background: In contrast to its use in idiopathic recurrent pericarditis (IRP), efficacy and optimal treatment duration of Anakinra are unclear in pericarditis secondary to known autoimmune or inflammatory conditions. Objectives: a) Assess the efficacy of Anakinra in secondary and idiopathic pericarditis, refractory or intolerant to conventional therapy (CT; colchicine and corticosteroid [CS]). b) Study the effect of extended Anakinra continuation on post-treatment relapse risk. Methods: Retrospective chart review of 12 adults hospitalised between January 2016 and October 2018 treated with Anakinra 100mg SQ daily for pericarditis refractory or intolerant to CT (CT+A group), and 22 consecutive hospitalised patients treated with CT only (CT group). Results: Diagnosed autoimmune or inflammatory condition was present in 83.3% (10/12) of CT+A and 40.9% (9/22) of CT group (p=0.07, Table 1 ). The most common etiologies in CT+A group were RA and Undifferentiated Connective Tissue/Overlap Disease ( Figure 1 ). Despite CT-intolerance or resistance ( Figure 2 ), all CT+A (12/12) patients had symptom relief at discharge vs. 72.7% (16/22) in CT group (p=0.04). There was a strong trend in CT+A compared to CT group towards shorter time to symptom improvement (1.75+/-1.29 vs. 3.55+/-3.06 days; p=0.06) and symptom relief (3.75+/-1.87 vs 5.63+/-3.28 days; p=0.08). CS were tapered successfully in 71.4% (5/7) vs. 66.7% (6/9) of patients in the CT+A and CT groups (p=0.56). Anakinra was associated with a longer mean length of stay (13.0+/-16.2 vs. 8.68+/-5.07 days; p=0.25). No recurrence during treatment was noted in CT+A group (0/12) vs. 40.9% (9/22) in CT group (p=0.009). There was a trend towards reduced post-treatment relapse risk in CT+A group [16.7% (2/12) vs. 41.7% (5/12), p=0.18]. In relapsed patients, there was no significant difference in time to relapse (1.75+/-0.34 vs 1.72+/-0.71 months, p=0.93). Within CT+A group, extended Anakinra use in 6 patients (mean: 5.58+/-6.5 months) did not reduce post-treatment relapse risk [16.7% (1/6) vs 16.7% (1/6), p>0.9]. Adverse effects were infrequent; elevated transaminases (n=1) and local injection-site reaction (n=1). Neither required permanent Anakinra discontinuation. Table 1 Baseline Characteristics Anakinra plus conventional therapy % (n=12) Conventional therapy only % (n=22) p-value Age (years +/- SD) 60.3+/-17.3 56.8+/-17.8 0.590 Female 66.7 (8) 50 (11) 0.349 Diagnosed autoimmune or inflammatory condition 83.3 (10) 40.9 (9) 0.074 Recurrent pericarditis (>1 episode) 33.3 (4) 27.3 (6) 0.710 Time since initial episode (months+/-SD) 49.0+/-79.9 9.21+/-11.7 0.441 Prior NSAID use 25.0 (3) 18.2 (4) 0.638 Prior Colchicine use 25.0 (3) 9.09 (2) 0.210 Prior CS use 50.0 (6) 18.2 (4) 0.051 Pericardial effusion on ECHO 75.0 (9) 81.8 (18) 0.638 Treatment during hospitalisation NSAID 50.0 (6) 54.5 (12) 0.799 Colchicine 58.3 (7) 63.6 (14) 0.761 CS 58.3 (7) 40.9 (9) 0.331 Risk factors for pericarditis PCI, cardiac surgery or chest trauma 16.7 (2) 45.5 (10) 0.093 Chest radiation 8.33 (1) 4.55 (1) 0.653 Malignancy 0 (0) 0 (0) Pericardial drainage 25.0 (3) 13.6 (3) 0.406 GFR<30 ml/min/1.73m 8.33 (1) 13.6 (3) 0.133 Family history of IRP 8.33 (1) 4.55 (1) 0.653 CRP, mg/L (mean+/-SD) 136+/-115 95.9+/-87.7 0.309 DM 8.33 (1) 27.3 (6) 0.191 HTN 25.0 (3) 63.6 (14) 0.031 Conclusion: In hospitalised patients with new-onset or recurrent pericarditis (secondary or idiopathic) refractory or intolerant to CT, Anakinra is associated with improved symptom relief and decreased recurrence risk. Extended continuation of Anakinra after symptom relief does not reduce post-treatment relapse risk. Disclosure of Interests: None declared DOI: 10.1136/annrheumdis-2019-eular.420Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1001Session: Other orphan diseases (Scientific Abstracts)