PMID- 38158463
OWN - NLM
STAT- MEDLINE
DCOM- 20240321
LR  - 20240321
IS  - 1970-9366 (Electronic)
IS  - 1828-0447 (Linking)
VI  - 19
IP  - 2
DP  - 2024 Mar
TI  - Effectiveness and safety of IL1 inhibition with anakinra in chronic refractory 
      idiopathic myocarditis.
PG  - 583-588
LID - 10.1007/s11739-023-03514-2 [doi]
AB  - 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.
CI  - (c) 2023. The Author(s), under exclusive licence to Societa Italiana di Medicina 
      Interna (SIMI).
FAU - Malandrino, Danilo
AU  - Malandrino D
AD  - Department of Experimental and Clinical Medicine, Internal Interdisciplinary 
      Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo 
      Brambilla 3, 50139, Florence, Italy.
FAU - Bello, Federica
AU  - Bello F
AD  - Department of Experimental and Clinical Medicine, Internal Interdisciplinary 
      Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo 
      Brambilla 3, 50139, Florence, Italy.
FAU - Lopalco, Giuseppe
AU  - Lopalco G
AD  - Department of Emergency and Organ Transplantation, Rheumatology Unit, University 
      of Bari Aldo Moro, Bari, Italy.
FAU - Cantarini, Luca
AU  - Cantarini L
AD  - Research Center of Systemic Autoinflammatory Diseases and Behcet's Disease, and 
      Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical 
      Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
FAU - Olivotto, Iacopo
AU  - Olivotto I
AD  - Department of Experimental and Clinical Medicine, University of Florence, IRCCS 
      Meyer Children's University Hospital, Florence, Italy.
FAU - Emmi, Giacomo
AU  - Emmi G
AD  - 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.
AD  - Centre for Inflammatory Diseases, Department of Medicine, Monash University, 
      Monash Medical Centre, Melbourne, Australia. giacomo.emmi@unifi.it.
FAU - Prisco, Domenico
AU  - Prisco D
AD  - Department of Experimental and Clinical Medicine, Internal Interdisciplinary 
      Medicine Unit, University of Florence Italy, Careggi University Hospital, Largo 
      Brambilla 3, 50139, Florence, Italy.
LA  - eng
PT  - Letter
PT  - Observational Study
DEP - 20231229
PL  - Italy
TA  - Intern Emerg Med
JT  - Internal and emergency medicine
JID - 101263418
RN  - 0 (Interleukin 1 Receptor Antagonist Protein)
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Humans
MH  - *Myocarditis/drug therapy
MH  - Interleukin 1 Receptor Antagonist Protein/adverse effects
MH  - Stroke Volume
MH  - Retrospective Studies
MH  - Ventricular Function, Left/physiology
MH  - Contrast Media
MH  - Gadolinium
MH  - Chronic Disease
EDAT- 2024/01/02 11:41
MHDA- 2024/03/21 12:48
CRDT- 2023/12/29 23:21
PHST- 2023/08/22 00:00 [received]
PHST- 2023/12/11 00:00 [accepted]
PHST- 2024/03/21 12:48 [medline]
PHST- 2024/01/02 11:41 [pubmed]
PHST- 2023/12/29 23:21 [entrez]
AID - 10.1007/s11739-023-03514-2 [pii]
AID - 10.1007/s11739-023-03514-2 [doi]
PST - ppublish
SO  - Intern Emerg Med. 2024 Mar;19(2):583-588. doi: 10.1007/s11739-023-03514-2. Epub 
      2023 Dec 29.