A Brief Overview of Recurrent Pericarditis Management and the Potential of Rilonacept as a New Therapeutic Option

Gupta, Manasvi; Kaul, Subuhi; Velazquez, Genaro; Bandyopadhyay, Dhrubajyoti; Fonarow, Gregg C.; Klein, Allan L.; Ghosh, Raktim

doi:10.1007/s40256-021-00481-x

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Although potent and effective anti-inflammatory agents, glucocorticoids are associated with a wide range of adverse effects, including comorbidities associated with chronic steroid use, potentially adverse impacts on HRQoL, and anecdotally an increased rate of recurrences. [8][9][10]17,18 Glucocorticoids should be used at low doses (0.2-0.5 mg/kg) followed by a slow taper over 8-12 weeks. 16,18 Although routinely used as second-line therapy, the evidence supporting the efficacy of prednisone or other glucocorticoids in clinical trials is lacking.…”

Section: Treamentmentioning

confidence: 99%

“…[8][9][10]17,18 Glucocorticoids should be used at low doses (0.2-0.5 mg/kg) followed by a slow taper over 8-12 weeks. 16,18 Although routinely used as second-line therapy, the evidence supporting the efficacy of prednisone or other glucocorticoids in clinical trials is lacking.…”

Section: Treamentmentioning

confidence: 99%

“…As discussed above, previous studies have supported the hypothesis that IL-1 plays a critical role in driving the autoinflammatory process in patients with RP, suggesting that IL-1b may serve as a viable target for therapy. 10,17,18 The discovery of IL-1 in the pathogenesis of pericarditis has opened the door to investigation with therapy specific to IL-1 blockade. In general, patients with clear autoimmune mechanism of RP, ie, those associated with SLE, RA, or other autoimmune diseases have been excluded from IL-1-targeted trials.…”

Section: Treamentmentioning

confidence: 99%

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Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives

Thomas

Bonaventura²,

Vecchiè³

et al. 2024

Journal of Cardiovascular Pharmacology

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Recurrent pericarditis (RP) is the most troublesome complication of acute pericarditis reflecting an unresolving inflammation of the pericardial sac around the heart and associated with significant morbidity. Recent studies have shown interleukin-1 (IL-1) signaling to be central to the pathophysiology of cases of RP with evidence of activation of systemic inflammation. We herein review the literature and clinical trials discussing the utility of IL-1 blockade for RP. The early experience of IL-1 blockade with anakinra (Kineret) and its favorable safety profile paved the way for the clinical development of rilonacept (Arcalyst) and subsequent approval by the US FDA for RP. In patients with RP who have become colchicine-resistant and glucocorticoid-dependent, IL-1 blockade with rilonacept or anakinra effectively treats recurrences and prevents future flares and significantly improves quality of life.

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Section: Treamentmentioning

confidence: 99%

Section: Treamentmentioning

confidence: 99%

Section: Treamentmentioning

confidence: 99%

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Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives

Thomas

Bonaventura²,

Vecchiè³

et al. 2024

Journal of Cardiovascular Pharmacology

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“…6,7 Unfortunately, despite optimal treatment, approximately 15-30% of patients with acute pericarditis have a recurrence within 18 months. 6,[8][9][10] Almost half of them do not achieve complete remission and continue to have recurrent flares. [10][11][12] Many of these patients are refractory to colchicine and become corticosteroid-dependent with long-term side effects from steroids.…”

mentioning

confidence: 99%

Rilonacept and Other Interleukin-1 Inhibitors in the Treatment of Recurrent Pericarditis

Goel

Bandyopadhyay

Malik

et al. 2022

Cardiology in Review

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Pericarditis is the commonest form of pericardial disease. Unfortunately, despite optimal treatment, approximately 15-30% of patients with acute pericarditis have recurrence. Many of these patients are refractory to colchicine, and become corticosteroid-dependent. Recurrent pericarditis severely impairs quality of life, and is associated with significant morbidity. Inflammasome formation and overproduction of interleukin (IL)-1 have been found to drive the systemic inflammatory response in recurrent autoinflammatory pericarditis. Several IL-1 inhibitors have been evaluated for their usefulness as therapeutic options. Rilonacept is a dimeric fusion protein that functions as a soluble decoy receptor that binds to both IL-1α and IL-1β, thereby inhibiting the IL-1 pathway. It is safe and efficacious in the treatment of recurrent pericarditis in the RHAPSODY II and III trials. Anakinra is a recombinant IL-1 receptor antagonist that blocks the action of circulating IL-1α and IL-1β. It has also been shown to be safe and efficacious in the AIRTRIP and IRAP studies. Canakinumab is a selective human monoclonal antibody against IL-1β, and data on its use in recurrent pericarditis is scarce. Several questions regarding IL-1 inhibitor therapy, such as the duration of treatment and the recommended tapering protocols, as well as their use in special populations like pregnant or lactating women, remain unanswered and need to be addressed in future studies.

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Recent advances in pericarditis

Bizzi

Picchi

Mastrangelo

et al. 2022

European Journal of Internal Medicine

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A Brief Overview of Recurrent Pericarditis Management and the Potential of Rilonacept as a New Therapeutic Option

Cited by 3 publications

References 27 publications

Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives

Interleukin-1 Blockers for the Treatment of Recurrent Pericarditis: Pathophysiology, Patient-Reported Outcomes, and Perspectives

Rilonacept and Other Interleukin-1 Inhibitors in the Treatment of Recurrent Pericarditis

Recent advances in pericarditis

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