Interleukin-1 (IL-1) receptor antagonist (
anakinra) has been shown to be effective in
steroid-dependent recurrent
pericarditis resistant to nonsteroidal anti-inflammatory drugs (
NSAIDs) and
colchicine. We sought to evaluate the acute efficacy of
anakinra given early in patients with acute
pericarditis. We enrolled patients within 24 hours of presentation of a first or recurrent episode of acute
pericarditis who were experiencing severe
pain (≥6 in 11-point Likert scale), despite treatment with at least one dose of
NSAIDs and of
colchicine. The primary outcome was
pain relief at 24 hours. Subcutaneous
anakinra 100 mg was administered in all patients, whereas
NSAIDs and
colchicine were suspended for 24 hours. Serum levels of
interleukin-6 (IL-6) were measured at baseline and 24 hours. Data are reported as median (interquartile range). We treated 5 patients (4 male and 1 female; 38 [31-54] years old).
Anakinra significantly reduced
pain from 6.0 (6.0-7.5) to 4.0 (2.5-4.0) at 6 hours (P = 0.012 vs. baseline) and to 2.0 (1.5-2.5) at 24 hours (P = 0.0025 vs. baseline). No patients required rescue
pain medication.
IL-6 levels were also significantly reduced from 95.3 (24.2-155.1) to 23.9 (4.5-71.9) pg/mL at 24 hours (P = 0.037). The reduction in
pain intensity paralleled the reduction in
IL-6 serum levels (R = +0.966, P = 0.007). No adverse events related to treatment occurred. The administration of
anakinra given early in acute
pericarditis treatment course rapidly and significantly improved
chest pain from acute
pericarditis. The improvement is correlated with a reduction in
IL-6 levels.