PO:19:284 | Use of anakinra during pregnancy and breastfeeding in women with recurrent pericarditis: a case series

Lucia Trotta¹, Marco Quartarone¹, Francesco Cavaleri¹, Ruggiero Mascolo¹, Massimo Imazio³, Vartan Mardygan², Andreja Cerne Cercek⁴, Anne-Marie Claveau², Ludovico Luca Sicignano⁵, Massimo Pancrazi¹, Alida Caforio⁶, Andrea Silvio Giordani⁶, Serdal Ugurlu⁷, Alessandro Andreis⁸, Valentino Collini³, Enrico Tombetti⁹, Antonio Brucato⁹ | ¹Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy; ²Division of Cardiology, Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada; ³Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy; ⁴Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; ⁵Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ⁶Division of Cardiology, Centro Gallucci, University of Padova-Policlinico, Padova, Italy; ⁷Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey; ⁸University Cardiology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; ⁹Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, University of Milan, Milan, Italy

Introduction. Recurrent pericarditis poses significant challenges in pregnant and breastfeeding women, requiring treatments that balance maternal health with fetal safety. Anakinra is a recombinant form of human interleukin-1 receptor antagonist, and is effective in managing recurrent pericarditis resistant to standard therapies. However, limited data exist on its safety during conception, pregnancy, and lactation, partly due to the rarity of systemic autoinflammatory diseases and the exclusion of reproductive-age women from trials.

Methods. Women with idiopathic, colchicine-resistant, corticosteroid-dependent recurrent pericarditis treated with anakinra during pregnancy were analyzed. Data included maternal age, medical history, pregnancy outcomes, delivery details, adverse events, and neonatal health, including APGAR scores, birth weight, congenital abnormalities, and breastfeeding outcomes.

Results. Fourteen women were treated with anakinra during pregnancy, leading to 16 newborns and two early abortions. One pregnancy is still ongoing. Maternal and neonatal outcomes were favorable, with no complications or adverse effects during pregnancy. There were no congenital anomalies or neonatal infections. Ten babies were breastfed while mothers continued anakinra without adverse effects. Recurrences of pericarditis occurred in nine pregnancies, during anakinra tapering, easily managed with dose adjustments.

Conclusions. Anakinra is a viable treatment for recurrent pericarditis in pregnant and breastfeeding women when conventional therapies fail. While current evidence supports its safety and efficacy, further studies are essential to establish comprehensive treatment guidelines. Multidisciplinary management is important to optimize maternal and neonatal outcomes.