Use of anakinra during pregnancy and breastfeeding in women with recurrent pericarditis: A case series

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 natural occurring 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 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 17 newborns and two early abortions. Maternal and neonatal outcomes were favorable, with no complications or adverse effects during pregnancy. There were no congenital anomalies or neonatal infections. Eleven babies were breastfed while mothers continued anakinra without adverse effects. Recurrences of pericarditis occurred during nine pregnancies, easily managed with dose adjustments. Conclusion: Anakinra appears to be a viable treatment for recurrent pericarditis in pregnant and breastfeeding women with recurrent pericarditis 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.