Management
Randomized clinical trials have shown that IL-1 blockade with anakinra (a recombinant IL-1 receptor antagonist) and rilonacept (an IL-1α and IL-1β trap) reduces recurrences in patients with multiple recurrences of pericarditis [PMID:35311434].
IL-1 blockers are recommended for patients with multiple recurrences and evidence of pericardial and systemic inflammation to interrupt the cycle of auto-inflammatory flares [PMID:35311434].
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) serve as the mainstay of therapy for acute and recurrent pericarditis, with colchicine potentially used as an adjunct, particularly for recurrent cases [PMID:22661042].
Corticosteroids are considered a second-line option for managing difficult cases or specific conditions such as systemic autoimmune diseases, postpericardiotomy syndromes, and pregnancy [PMID:22661042].
Medical therapy should be tailored individually, ensuring continuous symptom control and normalization of C-reactive protein levels through regular dosing (every 8 hours) until remission is achieved, followed by a tapering regimen [PMID:22661042].
Key Recommendations
Given the evidence supporting the efficacy of IL-1 inhibitors in reducing recurrences, guidelines should include recommendations for their use in managing recurrent pericarditis [PMID:35311434]. (Evidence: Expert opinion)
References
1 Vecchié A, Del Buono MG, Mauro AG, Cremer PC, Imazio M, Klein AL et al.. Advances in pharmacotherapy for acute and recurrent pericarditis. Expert opinion on pharmacotherapy 2022. link 2 Imazio M, Adler Y. Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart failure reviews 2013. link
2 papers cited of 3 indexed.