Heart failure & cardiomyopathies

Time-dependent effects of interleukin-1 blockade by anakinra in myocarditis and inflammatory cardiomyopathy

Eur J Heart FailPublished Cohort study

Authors' conclusion

Anakinra was associated with a marked reduction in MAE during active treatment, with re-emergence after discontinuation, supporting a potential role for sustained IL-1 blockade in selected high-risk patients.

Study context

Population
Patients with definite myocarditis or inflammatory cardiomyopathy diagnosed by CMR with or without endomyocardial biopsyfollow-up 51 ± 20 months
Participants
42 patients
Exposure
Anakinra treatment phase vs pre-treatment and post-discontinuation phases
Outcome
Major adverse events:
  • Cardiac death
  • Heart transplantation
  • Major ventricular arrhythmias
  • Hospitalization for acute HF
  • Recurrent myocarditis
Methodological detailsconsecutive patients, time-updated Kaplan-Meier analysis
  • Consecutive patients
  • Time-updated Kaplan-Meier analysis

Main finding

As reported in the abstract

MAE
  • Events rare during active treatment; most deaths (7/8) and all major ventricular arrhythmias occurred outside the treatment phase
  • During treatment vs Pre-treatment and post-discontinuation: P < 0.001
  • Time-updated Kaplan-Meier analysis

Observational data: associations, not effects.

Further findings

OutcomeDuring treatmentPre-treatmentPost-discontinuationP value
Recurrent myocarditisDuring treatment vs Pre-treatment1/42 events9/32 events3/37 eventsP = 0.002

Cardiac-related hospitalizations

Decreased during treatment and increased thereafter

Troponin, left ventricular ejection fraction (LVEF), CMR inflammatory abnormalities, arrhythmic burden

Improvements paralleling major adverse events (MAE) changes; LVEF improved ≥5% in one-third

Original publication

Time-dependent effects of interleukin-1 blockade by anakinra in myocarditis and inflammatory cardiomyopathy. Eur J Heart Fail. Published 26 June 2026. doi:10.1093/ejhf/xuag194

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