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A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis
Summary Idiopathic recurrent pericarditis (IRP) impairs quality of life. Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are...
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Published in: | Journal of cardiology cases 2011-10, Vol.4 (2), p.e93-e97 |
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creator | Scott, Ian C., MBChB, MRCP, MSc Hajela, Vijay, MBBS, FRCP Hawkins, Philip N., PhD, FRCP, FRCPath Lachmann, Helen J., MD, FRCP |
description | Summary Idiopathic recurrent pericarditis (IRP) impairs quality of life. Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are often used, however may promote recurrences. European guidelines advocate azathioprine or cyclophosphamide in refractory cases despite limited evidence. We report two adults with IRP successfully treated with the interleukin-1 antagonist, anakinra. We combine this experience with the first systematic literature review of immunosuppression in IRP. A total of 8 papers were included in the review, which alongside our patients described 18 cases. The best treatments comprised anakinra and intravenous immunoglobulin, with respective remission rates of 100% and 67%. Cyclophosphamide and azathioprine were less efficacious. The unprovoked inflammatory episodes in our patients alongside their prompt response to anakinra indicate that in some instances IRP may represent an autoinflammatory condition. We suggest that in IRP refractory to initial treatment, anakinra should be considered as a potential therapy. Clinical trials are required to confirm its benefits in IRP. |
doi_str_mv | 10.1016/j.jccase.2011.07.003 |
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Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are often used, however may promote recurrences. European guidelines advocate azathioprine or cyclophosphamide in refractory cases despite limited evidence. We report two adults with IRP successfully treated with the interleukin-1 antagonist, anakinra. We combine this experience with the first systematic literature review of immunosuppression in IRP. A total of 8 papers were included in the review, which alongside our patients described 18 cases. The best treatments comprised anakinra and intravenous immunoglobulin, with respective remission rates of 100% and 67%. Cyclophosphamide and azathioprine were less efficacious. The unprovoked inflammatory episodes in our patients alongside their prompt response to anakinra indicate that in some instances IRP may represent an autoinflammatory condition. We suggest that in IRP refractory to initial treatment, anakinra should be considered as a potential therapy. Clinical trials are required to confirm its benefits in IRP.</description><identifier>ISSN: 1878-5409</identifier><identifier>EISSN: 1878-5409</identifier><identifier>DOI: 10.1016/j.jccase.2011.07.003</identifier><identifier>PMID: 30534275</identifier><language>eng</language><publisher>Japan: Japanese College of Cardiology</publisher><subject>Cardiovascular</subject><ispartof>Journal of cardiology cases, 2011-10, Vol.4 (2), p.e93-e97</ispartof><rights>Japanese College of Cardiology</rights><rights>2011 Japanese College of Cardiology. 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Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are often used, however may promote recurrences. European guidelines advocate azathioprine or cyclophosphamide in refractory cases despite limited evidence. We report two adults with IRP successfully treated with the interleukin-1 antagonist, anakinra. We combine this experience with the first systematic literature review of immunosuppression in IRP. A total of 8 papers were included in the review, which alongside our patients described 18 cases. The best treatments comprised anakinra and intravenous immunoglobulin, with respective remission rates of 100% and 67%. Cyclophosphamide and azathioprine were less efficacious. The unprovoked inflammatory episodes in our patients alongside their prompt response to anakinra indicate that in some instances IRP may represent an autoinflammatory condition. We suggest that in IRP refractory to initial treatment, anakinra should be considered as a potential therapy. Clinical trials are required to confirm its benefits in IRP.</description><subject>Cardiovascular</subject><issn>1878-5409</issn><issn>1878-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNpVkV1rFTEQhoMottT-A5FcenO2-dyPG6EUPwoFL9TrkJPM2mx3kzWz23L-vVlPrTUEMjAz70zeh5C3nFWc8fpiqAbnLEIlGOcVayrG5Atyytum3WnFupfP4hNyjjiwciRXrW5fkxPJtFSi0adkvaSbDkXIAZDa6CkecIHJLsHRMSyQ7bJmoBnuAzzQ1Jcaexditn-KwzStMeE6zxkQQ4o0lOtDmu1yWxQyuDVniAudywRnsw9LwDfkVW9HhPPH94z8-PTx-9WX3c3Xz9dXlzc7p5iQu8Z5Xyvf8LrvOsGh3WsnhReqkb1sWmW1hbpVUgrXsbYkGAe17zQDqTyvhTwjH46687qfwLuyR7ajmXOYbD6YZIP5PxPDrfmZ7k0tas06XQTePwrk9GsFXMwU0ME42ghpRSO41rxWQmyz1LHU5YSYoX8aw5nZoJnBHKGZDZphjSlEStu75ys-Nf1F9O8PUIwqDLJxY4jFyvEODoBDWnMsHhpuUBhmvm3cN-ycF-JaSvkbzfisUQ</recordid><startdate>201110</startdate><enddate>201110</enddate><creator>Scott, Ian C., MBChB, MRCP, MSc</creator><creator>Hajela, Vijay, MBBS, FRCP</creator><creator>Hawkins, Philip N., PhD, FRCP, FRCPath</creator><creator>Lachmann, Helen J., MD, FRCP</creator><general>Japanese College of Cardiology</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201110</creationdate><title>A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis</title><author>Scott, Ian C., MBChB, MRCP, MSc ; Hajela, Vijay, MBBS, FRCP ; Hawkins, Philip N., PhD, FRCP, FRCPath ; Lachmann, Helen J., MD, FRCP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4023-7cdd64d716f9921e8b5c32d2473f3784a5ae684332c9082d201e4b950e34d1623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Cardiovascular</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scott, Ian C., MBChB, MRCP, MSc</creatorcontrib><creatorcontrib>Hajela, Vijay, MBBS, FRCP</creatorcontrib><creatorcontrib>Hawkins, Philip N., PhD, FRCP, FRCPath</creatorcontrib><creatorcontrib>Lachmann, Helen J., MD, FRCP</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cardiology cases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scott, Ian C., MBChB, MRCP, MSc</au><au>Hajela, Vijay, MBBS, FRCP</au><au>Hawkins, Philip N., PhD, FRCP, FRCPath</au><au>Lachmann, Helen J., MD, FRCP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis</atitle><jtitle>Journal of cardiology cases</jtitle><addtitle>J Cardiol Cases</addtitle><date>2011-10</date><risdate>2011</risdate><volume>4</volume><issue>2</issue><spage>e93</spage><epage>e97</epage><pages>e93-e97</pages><issn>1878-5409</issn><eissn>1878-5409</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Summary Idiopathic recurrent pericarditis (IRP) impairs quality of life. Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are often used, however may promote recurrences. European guidelines advocate azathioprine or cyclophosphamide in refractory cases despite limited evidence. We report two adults with IRP successfully treated with the interleukin-1 antagonist, anakinra. We combine this experience with the first systematic literature review of immunosuppression in IRP. A total of 8 papers were included in the review, which alongside our patients described 18 cases. The best treatments comprised anakinra and intravenous immunoglobulin, with respective remission rates of 100% and 67%. Cyclophosphamide and azathioprine were less efficacious. The unprovoked inflammatory episodes in our patients alongside their prompt response to anakinra indicate that in some instances IRP may represent an autoinflammatory condition. We suggest that in IRP refractory to initial treatment, anakinra should be considered as a potential therapy. Clinical trials are required to confirm its benefits in IRP.</abstract><cop>Japan</cop><pub>Japanese College of Cardiology</pub><pmid>30534275</pmid><doi>10.1016/j.jccase.2011.07.003</doi><oa>free_for_read</oa></addata></record> |
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source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS; Open Access: PubMed Central; ScienceDirect Freedom Collection |
subjects | Cardiovascular |
title | A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis |
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