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

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Abstract

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.

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Data availability

Data are available upon reasonable request to the corresponding author.

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Author information

Author notes

  1. Danilo Malandrino and Federica Bello: These authors share first authorship.

  2. Giacomo Emmi and Domenico Prisco: Senior contributors to the manuscript.

Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, Internal Interdisciplinary Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo Brambilla 3, 50139, Florence, Italy

    Danilo Malandrino, Federica Bello, Giacomo Emmi & Domenico Prisco

  2. Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari Aldo Moro, Bari, Italy

    Giuseppe Lopalco

  3. 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

    Luca Cantarini

  4. Department of Experimental and Clinical Medicine, University of Florence, IRCCS Meyer Children’s University Hospital, Florence, Italy

    Iacopo Olivotto

  5. Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Melbourne, Australia

    Giacomo Emmi

Authors
  1. Danilo Malandrino
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  2. Federica Bello
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  3. Giuseppe Lopalco
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  4. Luca Cantarini
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  5. Iacopo Olivotto
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  6. Giacomo Emmi
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  7. Domenico Prisco
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Corresponding author

Correspondence to Giacomo Emmi.

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Human and animal rights

The study was approved by local ethical committees, according to the Declaration of Helsinki.

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All the patients signed an informed consent.

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Malandrino, D., Bello, F., Lopalco, G. et al. Effectiveness and safety of IL1 inhibition with anakinra in chronic refractory idiopathic myocarditis. Intern Emerg Med 19, 583–588 (2024). https://doi.org/10.1007/s11739-023-03514-2

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  • DOI: https://doi.org/10.1007/s11739-023-03514-2

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