Anakinra Weaning Protocol — EECC MCQ
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Correct answer: C — Gradual anakinra taper after sustained remission
Anakinra (and rilonacept) weaning in recurrent pericarditis per the 2025 ESC Pericarditis Guidelines and expert consensus: (1) ensure: complete symptom resolution, normal CRP for ≥3-6 months, no pericardial effusion, on stable colchicine (if tolerated — continue throughout weaning as backbone); (2) GRADUAL dose reduction: reduce frequency (daily → every other day → twice weekly → weekly → stop) over months; (3) monitor CRP closely during weaning (every 2-4 weeks) — any CRP rise or symptom recurrence should prompt dose increase back to the last effective dose; (4) recurrence rate after discontinuation: 30-50% (some patients require long-term or indefinite therapy); (5) colchicine should be continued throughout the weaning process and for ≥6 months after anakinra cessation. The high recurrence rate reflects the chronic autoinflammatory nature of the underlying condition in many patients with colchicine-resistant recurrent pericarditis.
Reference: ESC (2025): Myocarditis/Pericarditis Guidelines: https://bnf.nice.org.uk/