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Caorsi R, Insalaco A, Bovis F, Martini G, Cattalini M, Chinali M, Rimini A, Longo C, Federici S, Celani C, Filocamo G, Consolini R, Maggio MC, Fadanelli G, Licciardi F, Romano M, Teruzzi BL, Taddio A, Miniaci A, La Torre F, De Fanti A, Cavalli G, Bigucci B, Gallizzi R, Chinello M, Imazio M, Brucato A, Cimaz R, De Benedetti F, Gattorno M. Pediatric Recurrent Pericarditis: Appropriateness of the Standard of Care and Response to IL-1 Blockade. J Pediatr 2023; 256:18-26.e8. [PMID: 36470465 DOI: 10.1016/j.jpeds.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE 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. STUDY DESIGN 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. RESULTS 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 < .0001); an increase to 0.83 was observed after the reduction/withdrawal of treatment (P < .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 At last follow-up, only 9 of the 58 patients had withdrawn all treatments.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. CONCLUSIONS 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. The different rate of response to anakinra and canakinumab may suggest a possible role of IL-1α in the pathogenesis of recurrent pericarditis.
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Affiliation(s)
- Roberta Caorsi
- Center of Autoinflammatory Diseases and Immunodeficiencies, Department of Pediatrics and Rheumatology, IRCCS Istituto G. Gaslini, Genova, Italy.
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Giorgia Martini
- Pediatric Rheumatology Unit, University of Padua, Padova, Italy
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marcello Chinali
- Pediatric Cardiology e Cardio-Surgery, IRRCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | | | - Chiara Longo
- Department of Pediatrics, University of Genoa, Genova, Italy
| | - Silvia Federici
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Camilla Celani
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giovanni Filocamo
- Division of Pediatric Immunology and Rheumatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rita Consolini
- Department of Pediatrics, Università di Pisa, Pisa, Italy
| | | | | | - Francesco Licciardi
- Immuno-Rheumatology Unit, Ospedale Infantile Regina Margherita, Torino, Italy
| | | | - Barbara Lia Teruzzi
- Department of Pediatric Rheumatology, ASST GOM Niguarda Milano, Milan, Italy
| | - Andrea Taddio
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" and Univeristy of Trieste, Trieste, Italy
| | - Angela Miniaci
- Pediatric Unit, Program of Pediatric Rheumatology, Immunology and Pneumo-Allergology, Policlinico S. Orsola-Malpighi Bologna, Bologna, Italy
| | - Francesco La Torre
- Department of Pediatrics, Pediatric Rheumatology Section, "Giovanni XXIII" Pediatric Hospital, Bari, Italy
| | | | - Giulio Cavalli
- Clinical Immunology and Rheumatology Unit, Ospedale San Raffaele, Milano, Italy
| | | | - Romina Gallizzi
- Pediatric Unit, Department of Medical of Health Sciencies Magna Grecia, University of Catanzaro, Catanzaro, Italy
| | - Matteo Chinello
- Pediatric Onco-Ematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona Ospedale Donna Bambino, Verona, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Antonio Brucato
- L. Sacco Department of Clinical and Biomedical Science, Università degli studi di Milano, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health and RECAP-RD, University of Milan, Italy
| | | | - Marco Gattorno
- Center of Autoinflammatory Diseases and Immunodeficiencies, Department of Pediatrics and Rheumatology, IRCCS Istituto G. Gaslini, Genova, Italy
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