Cerne Cercek Andreja, Gomiscek Novak Alja, Trojner Bregar Andreja, Avcin Tadej, Kessel Christoph, Thurner Lorenz, Fadle Natalie, Cercek Miha
Department of Cardiology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia.
Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slajmerjeva cesta 3, 1000 Ljubljana, Slovenia.
Eur Heart J Case Rep. 2025 Jun 5;9(6):ytaf280. doi: 10.1093/ehjcr/ytaf280. eCollection 2025 Jun.
Anakinra, an interleukin-1 receptor antagonist (IL-1 Ra), is a treatment option for recurrent pericarditis refractory to conventional therapy. However, some patients cannot discontinue anakinra treatment without relapse. This is of particular concern for women of childbearing age, as data on its safety during pregnancy and lactation is limited.
We report the case of a 36-year-old White woman with recurrent pericarditis of an inflammatory phenotype. Pericardial biopsy revealed virus-negative fibro-productive pericarditis, and genetic testing showed no identifiable cause. Despite treatment with non-steroidal anti-inflammatory drugs, colchicine, and corticosteroids, the patient experienced multiple recurrences and developed corticosteroid-related side effects. Introduction of anakinra resulted in immediate clinical improvement and allowed corticosteroid withdrawal. However, several attempts to discontinue anakinra led to pericarditis recurrences. The patient tested positive for neutralizing anti-IL-1Ra antibodies. During the stable phase of the disease, as confirmed by cardiac magnetic resonance imaging, and while on anakinra and colchicine, she conceived spontaneously. She maintained anakinra treatment throughout the full-term pregnancy and breastfeeding, with no impact on foetal or child development.
Our paper provides evidence supporting the safe use of anakinra in pregnancy and lactation in a patient with recurrent pericarditis. It also reports the first case of anti-IL-1Ra antibodies in a patient receiving anakinra for recurrent pericarditis, which may help explain the dependency on the medication. The potential role of these antibodies as biomarkers for anakinra dependency or tools for optimizing immunosuppressive treatment warrants further research. A patient-centred counselling and a multidisciplinary approach are essential for achieving optimal outcomes.
阿那白滞素是一种白细胞介素-1受体拮抗剂（IL-1 Ra），是传统治疗难治性复发性心包炎的一种治疗选择。然而，一些患者在停用阿那白滞素治疗后会复发。这对于育龄女性尤为重要，因为其在妊娠和哺乳期的安全性数据有限。
我们报告了一例36岁白人女性复发性炎性心包炎的病例。心包活检显示病毒阴性的纤维增生性心包炎，基因检测未发现明确病因。尽管使用了非甾体抗炎药、秋水仙碱和皮质类固醇进行治疗，患者仍多次复发，并出现了与皮质类固醇相关的副作用。引入阿那白滞素后临床症状立即改善，并停用了皮质类固醇。然而，多次尝试停用阿那白滞素均导致心包炎复发。患者中和抗IL-1Ra抗体检测呈阳性。在疾病稳定期，经心脏磁共振成像证实，在使用阿那白滞素和秋水仙碱期间，她自然受孕。她在整个足月妊娠和母乳喂养期间一直使用阿那白滞素治疗，对胎儿或儿童发育没有影响。
我们的论文提供了证据，支持在复发性心包炎患者中妊娠和哺乳期安全使用阿那白滞素。它还报告了首例接受阿那白滞素治疗复发性心包炎患者出现抗IL-1Ra抗体的病例，这可能有助于解释对该药物的依赖性。这些抗体作为阿那白滞素依赖性生物标志物或优化免疫抑制治疗工具的潜在作用值得进一步研究。以患者为中心的咨询和多学科方法对于实现最佳结果至关重要。
