Pediatric Recurrent Pericarditis: Appropriateness of the Standard of Care and Response to IL-1 Blockade

To analyze, in a cohort of pediatric patients with recurrent pericarditis undergoing anti-interleukin (IL)-1 treatment: the agent and dosing used as first-line treatment, the long-term efficacy of IL-1 blockers, the percentage of patients achieving a drug-free remission, and the presence of variable...

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Veröffentlicht in:The Journal of pediatrics 2023-05, Vol.256, p.18-26.e8
Hauptverfasser: Caorsi, Roberta, Insalaco, Antonella, Bovis, Francesca, Martini, Giorgia, Cattalini, Marco, Chinali, Marcello, Rimini, Alessandro, Longo, Chiara, Federici, Silvia, Celani, Camilla, Filocamo, Giovanni, Consolini, Rita, Maggio, Maria Cristina, Fadanelli, Gloria, Licciardi, Francesco, Romano, Micol, Teruzzi, Barbara Lia, Taddio, Andrea, Miniaci, Angela, La Torre, Francesco, De Fanti, Alessandro, Cavalli, Giulio, Bigucci, Barbara, Gallizzi, Romina, Chinello, Matteo, Imazio, Massimo, Brucato, Antonio, Cimaz, Rolando, De Benedetti, Fabrizio, Gattorno, Marco
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container_title The Journal of pediatrics
container_volume 256
creator Caorsi, Roberta
Insalaco, Antonella
Bovis, Francesca
Martini, Giorgia
Cattalini, Marco
Chinali, Marcello
Rimini, Alessandro
Longo, Chiara
Federici, Silvia
Celani, Camilla
Filocamo, Giovanni
Consolini, Rita
Maggio, Maria Cristina
Fadanelli, Gloria
Licciardi, Francesco
Romano, Micol
Teruzzi, Barbara Lia
Taddio, Andrea
Miniaci, Angela
La Torre, Francesco
De Fanti, Alessandro
Cavalli, Giulio
Bigucci, Barbara
Gallizzi, Romina
Chinello, Matteo
Imazio, Massimo
Brucato, Antonio
Cimaz, Rolando
De Benedetti, Fabrizio
Gattorno, Marco
description To analyze, in a cohort of pediatric patients with recurrent pericarditis undergoing anti-interleukin (IL)-1 treatment: the agent and dosing used as first-line treatment, the long-term efficacy of IL-1 blockers, the percentage of patients achieving a drug-free remission, and the presence of variables associated with drug-free remission. Data were collected from patients’ charts. The annualized relapse rate (ARR) was used for evaluation of treatment efficacy, and bivariate logistic regression analysis was used for variables associated with drug-free remission. Fifty-eight patients, treated between 2008 and 2018, were included in the study (mean follow-up. 2.6 years). Of the 56 patients treated with first-line drugs, 14 not responsive patients were underdosed. Fifty-seven patients were treated with anakinra: the ARR before and during daily treatment was 3.05 and 0.28, respectively (P 
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Data were collected from patients’ charts. The annualized relapse rate (ARR) was used for evaluation of treatment efficacy, and bivariate logistic regression analysis was used for variables associated with drug-free remission. Fifty-eight patients, treated between 2008 and 2018, were included in the study (mean follow-up. 2.6 years). Of the 56 patients treated with first-line drugs, 14 not responsive patients were underdosed. Fifty-seven patients were treated with anakinra: the ARR before and during daily treatment was 3.05 and 0.28, respectively (P &lt; .0001); an increase to 0.83 was observed after the reduction/withdrawal of treatment (P &lt; .0001). The switch from anakinra to canakinumab (5 patients) was associated to an increase of the ARR (0.49 vs 1.46), but without statistical significance (P = .215). At last follow-up, only 9 of the 58 patients had withdrawn all treatments. With the limits of a retrospective study and the heterogeneity between the patients enrolled in the study, a shorter duration of treatment with anakinra was the only variable associated with drug-free remission. This study shows that most pediatric patients with recurrent pericarditis needing IL-1 blockade received an inadequate treatment with first-line agents. The effectiveness of anakinra is supported by this study, but few patients achieved drug-free remission. 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With the limits of a retrospective study and the heterogeneity between the patients enrolled in the study, a shorter duration of treatment with anakinra was the only variable associated with drug-free remission. This study shows that most pediatric patients with recurrent pericarditis needing IL-1 blockade received an inadequate treatment with first-line agents. The effectiveness of anakinra is supported by this study, but few patients achieved drug-free remission. 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subjects anti-inflammatory agents nonsteroidal
Child
colchicine
Humans
Interleukin 1 Receptor Antagonist Protein - therapeutic use
interleukin-1
Interleukin-1 - therapeutic use
pericarditis
Pericarditis - drug therapy
Recurrence
Retrospective Studies
Standard of Care
steroids
therapy
Treatment Outcome
title Pediatric Recurrent Pericarditis: Appropriateness of the Standard of Care and Response to IL-1 Blockade
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