Effectiveness and safety of IL1 inhibition with anakinra in chronic refractory idiopathic myocarditis.

Autor: Malandrino D; Department of Experimental and Clinical Medicine, Internal Interdisciplinary Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy., Bello F; Department of Experimental and Clinical Medicine, Internal Interdisciplinary Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy., Lopalco G; Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy., Cantarini L; Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy., Olivotto I; Department of Experimental and Clinical Medicine, University of Florence, IRCCS Meyer Children's University Hospital, Florence, Italy., Emmi G; Department of Experimental and Clinical Medicine, Internal Interdisciplinary Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy. giacomo.emmi@unifi.it.; Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Melbourne, Australia. giacomo.emmi@unifi.it., Prisco D; Department of Experimental and Clinical Medicine, Internal Interdisciplinary Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2024 Mar; Vol. 19 (2), pp. 583-588. Date of Electronic Publication: 2023 Dec 29.
DOI: 10.1007/s11739-023-03514-2
Abstrakt: Aim: The aim of this study was to evaluate the effectiveness and safety of the anti-IL-1 receptor anakinra in patients with chronic active myocarditis refractory to standard therapy.
Methods and Results: In this retrospective, observational study, we enrolled 6 patients with chronically active myocarditis treated with anakinra on-top-of standard treatment. Response to treatment was evaluated at different time points [disease onset (T0), anakinra beginning (T1), three months from anakinra beginning (T2), last available follow-up (T3)], and was assessed by variations in New York Heart Association (NYHA) functional class, laboratory tests [C-reactive protein (CRP), a high-sensitivity cardiac troponin T (cTnT), and Nt-proBNP], left ventricular ejection fraction (LVEF), and cardiac magnetic resonance (CMR) edema or late gadolinium enhancement. The number of premature ventricular complexes (PVCs) at 24-h EKG-recordings was considered in patients with arrhythmic manifestations. No differences were found between T0 and T1 in terms of CRP, Nt-ProBNP, and LVEF. Before anakinra beginning, all patients were still symptomatic. At T2, all patients were symptom-free, in NYHA class I. A significant decrease in CRP (p = 0.03) and a significant improvement in LVEF (p = 0.03) were observed. Sustained arrhythmic manifestations were found in 4 out of 6 patients. In this subgroup, anakinra showed effectiveness in reducing the arrhythmic burden. At T3, the improvement in laboratory values and cardiac function persisted. The arrhythmic burden remained abated.
Conclusions: All patients had a rapid improvement in systemic inflammation, cardiac function, and arrhythmic burden with anti-IL1 therapy, indicating that anakinra may be an effective treatment in chronic active idiopathic myocarditis, refractory to standard treatment.
(© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
Externí odkaz: