Early Introduction and Prolonged Full‐Dose Anakinra Reduce Recurrence Risk After Discontinuation in Recurrent Pericarditis: An International Multicenter Cohort

Abstract

Background Anakinra is effective in recurrent pericarditis, yet optimal treatment duration and strategies for safe drug discontinuation remain uncertain. Identifying predictors of sustained remission after discontinuation is important for clinical management. Methods We retrospectively analyzed 185 consecutive adult patients with corticosteroid‐dependent and colchicine‐resistant refractory recurrent pericarditis across 16 international referral centers, who permanently discontinued therapy after clinical remission. The primary end point was pericarditis recurrence after drug discontinuation. Univariate and multivariable Cox proportional hazards regression and Kaplan‐Meier analyses were performed to identify demographic, clinical, and therapeutic predictors of postdiscontinuation relapse. Results Among 185 patients who discontinued anakinra (58.4% women, mean age 50.4±17.8 years, 77% idiopathic cause), treatment was initiated a median of 10 months (interquartile range [IQR], 4.0–19.5) after the first episode and continued at 100 mg/d for a median of 6 months (IQR, 4–12). Over a median follow‐up of 7.2 months (IQR, 1.5–23.3) after discontinuation, 68 patients (36.8%) experienced recurrence, with a median time to recurrence of 2.1 months (IQR, 0.7–8.5). Initiation within 12 months from the first pericarditis episode and maintenance of full‐dose therapy (100 mg/d) for ≥6 months were independently associated with lower recurrence risk (hazard ratio [HR], 0.33 [95% CI, 0.18–0.66]; P =0.001 and HR, 0.48 [95% CI, 0.23–0.86]; P =0.017; respectively). Conclusions Early initiation of anakinra and maintenance of full‐dose therapy 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.