To the Editor:

We thank Dr. Brucato and colleagues for their comments and are glad that they agree with our suggestion that IL-1 inhibition could represent a therapeutic option in some patients with idiopathic recurrent pericarditis. In this respect, the recent availability of more potent IL-1 inhibitors is also of particular interest. The long-acting interleukin-1 inhibitor rilonacept (interleukin-1 Trap) has proven effective in the treatment of familial cold-induced autoinflammatory syndrome (1). Moreover, in a recent study on the efficacy of a monoclonal antibody against IL-1 (canakinumab) in children with systemic juvenile idiopathic arthritis, our group observed that, in patients who showed a notable response to the treatment, a single dose of the antibody induced a remission lasting for several weeks or months (2). Similar long-lasting remissions after a single injection of canakinumab have been observed in patients with autoinflammatory syndromes, such as cryopyrin-associated periodic syndrome (3). It could be hypothesized that patients with idiopathic recurrent pericarditis also may experience long-lasting remission after a single canakinumab injection. This would make IL-1 inhibition even more appealing as a potential treatment of recurrent idiopathic pericarditis.

Paolo Picco MD*, Alberto Martini MD*, * University of Genoa, Genoa, Italy.