Anakinra in COVID-19 and pericarditis

ABSTRACT

Background: Anakinra, an interleukin 1β recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL). Case Report A 88-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism. Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred. Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid. During hospitalization patient developed COVID-19. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies. Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra. Conclusions: given that Interleukin-1 (IL-1) is a pro-inflammatory cytokine that has been associated with severe COVID-19, in this case treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of therapy.