Figure 1
A patient with recurrent pericarditis who failed conventional therapy achieved remission with rilonacept. (A, B) CMR demonstrates positive LGE along with (C) edema evidenced by increased T2-STIR signal, findings consistent with active pericardial inflammation. In the same patient following rilonacept therapy, CMR demonstrated complete resolution of inflammation, with (D, E) a significant decrease in pericardial LGE and (F) no edema, as evidenced by a normal T2-STIR signal. CMR: cardiac magnetic resonance; LGE: late gadolinium enhancement; T2-STIR: T2-short tau inversion recovery
Table 1
Medications used in the treatment of recurrent pericarditis. NSAIDs: nonsteroidal anti-inflammatory drugs; PO: oral; IV: intravenous; SC: subcutaneous; q8h: every 8 hours; QD: once daily; BID: twice daily; CBC: complete blood count; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GI: gastrointestinal; PPI: proton pump inhibitor; TB: tuberculosis; URTI: upper respiratory tract infection; PCP: Pneumocystis jirovecii pneumonia; IL-1: interleukin-1; IVIG: intravenous immunoglobulin; HIV: human immunodeficiency virus
| MEDICATION CLASS | DOSE & ROUTE | DURATION | SIDE EFFECTS | MONITORING |
|---|---|---|---|---|
| NSAIDs: Ibuprofen, aspirin, indomethacin | Ibuprofen: 600–800 mg PO q8h Aspirin: 650–1000 mg PO q8h Indomethacin: 50 mg PO q8h | Until symptom/CRP normalization, then taper (typically weeks-months) | GI upset, ulceration, renal dysfunction, hypertension, fluid retention | CBC, renal function, liver enzymes, CRP/ESR, GI protection (PPI) |
| Colchicine | ≥ 70 kg: 0.5–0.6 mg PO BID < 70 kg: 0.5–0.6 mg PO QD (reduce for GI intolerance or drug interactions) | 3 months (first episode) ≥ 6 months (recurrence) | Diarrhea, nausea, vomiting, abdominal pain, alopecia, myopathy, neuropathy | CBC, renal and hepatic function, CRP/ESR, drug interactions |
| Corticosteroids: Prednisone | 0.2–0.5 mg/kg/day PO, slow taper after remission | Until remission, then slow taper (months) | Weight gain, hyperglycemia, osteoporosis, adrenal suppression, infection, hypertension, GI ulcers | CBC, glucose, bone density, CRP/ESR, infection risk, GI protection (PPI), consider PCP prophylaxis |
| Anti–IL-1 agents: Anakinra, rilonacept | Anakinra: 100 mg SC daily Rilonacept: 320 mg SC once, then 160 mg SC weekly | Variable (often ≥ 6–18 months; optimal duration unclear) | Injection site reactions, URTI, neutropenia, elevated liver enzymes, lipid changes | CBC, liver enzymes, lipid profile, CRP/ESR, screen for TB, hepatitis, HIV before initiation |
| Immuno-suppressants: Azathioprine | 1–2 mg/kg/day PO | Months-years (individualized) | Myelosuppression, hepatotoxicity, infection, GI upset | CBC, liver enzymes, CRP/ESR, infection risk |
| IVIG | 2 g/kg IV over 2–5 days (varies) | Variable (case-by-case) | Infusion reactions, headache, renal dysfunction, thrombosis | Renal function, CBC, CRP/ESR |
Table 2
Summary of randomized clinical trials (RCTs) evaluating therapies for recurrent pericarditis. NSAID: nonsteroidal anti-inflammatory drug; RCT: randomized clinical trial
| TRIAL NAME | INTERVENTION(S) | POPULATION/DESIGN | KEY FINDINGS/OUTCOMES |
|---|---|---|---|
| CORE | Colchicine vs placebo (with NSAID) | First recurrence, RCT, n = 84 | Colchicine reduced recurrence at 18 months (24% vs 51%) |
| CORP | Colchicine vs placebo (with NSAID) | Recurrent pericarditis, RCT, n = 120 | Colchicine reduced recurrence at 18 months (24% vs 55%) |
| CORP-2 | Colchicine vs placebo (with NSAID) | Multiple recurrences, RCT, n = 240 | Colchicine reduced recurrence at 6 months (21.6% vs 42.5%) |
| AIRTRIP | Anakinra vs placebo (withdrawal) | Colchicine-resistant, steroid-dependent, ≥ 3 recurrences, RCT, n = 21 | Recurrence: 18% (anakinra) vs 90% (placebo) after withdrawal; rapid symptom/CRP control |
| RHAPSODY | Rilonacept vs placebo (withdrawal) | ≥ 2 recurrences, colchicine-resistant/steroid-dependent, RCT, n = 61 | Recurrence: 7% (rilonacept) vs 74% (placebo); rapid pain/CRP resolution; steroid-sparing |
| Goflikicept | Goflikicept vs withdrawal | Recurrent pericarditis, RCT, n = 20 | Recurrence: 0% (Goflikicept) vs 90% (placebo) |
Table 3
Overview of forthcoming clinical trials investigating new therapies for recurrent pericarditis.
| TRIAL/SPONSOR NAME | INTERVENTION(S) | POPULATION/DESIGN | KEY FINDINGS/OUTCOMES |
|---|---|---|---|
| MAVERIC/Cardiol Therapeutics | CardiolRxTM vs placebo | Recurrent pericarditis, phase 3, ongoing | Primary outcome: recurrence; results pending |
| VENTYX | VTX2735 vs placebo | Recurrent pericarditis, phase 2, ongoing | Primary outcome: recurrence rate; results pending |
| KINIKSA | KPL-387 vs placebo | Recurrent pericarditis, phase 2, ongoing | Primary outcome: recurrence rate; results pending |