Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives.

Abstract: Recurrent pericarditis (RP) is the most troublesome complication of acute pericarditis reflecting an unresolving inflammation of the pericardial sac around the heart and associated with significant morbidity. Recent studies have shown interleukin-1 (IL-1) signaling to be central to the pathophysiology of cases of RP with evidence of activation of systemic inflammation. We herein review the literature and clinical trials discussing the utility of IL-1 blockade for RP. The early experience of IL-1 blockade with anakinra (Kineret) and its favorable safety profile paved the way for the clinical development of rilonacept (Arcalyst) and subsequent approval by the US FDA for RP. In patients with RP who have become colchicine-resistant and glucocorticoid-dependent, IL-1 blockade with rilonacept or anakinra effectively treats recurrences and prevents future flares and significantly improves quality of life.
Competing Interests: A. Klein is on the advisory board for Kiniksa Pharmaceuticals, Cardiol Therapeutics, and Pfizer. A. Abbate has received research grant funding and has served as a paid scientific advisor to GSK, Kiniksa Pharmaceuticals, Merck, Novartis, Olatec, Serpin Pharma, R-Pharm, and Swedish Orphan Biovitrum. The remaining authors report no conflicts of interest.
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