US Database Study of Clinical Burden and Unmet Need in Recurrent Pericarditis

Abstract

Background Patients with recurrent pericarditis (RP) may develop complications, multiple recurrences, or inadequate treatment response. This study aimed to characterize disease burden and unmet needs in RP. Methods and Results This retrospective US database analysis included newly diagnosed patients with RP with ≥24 months of continuous history following their first pericarditis episode. RP was defined as ≥2 pericarditis episodes ≥28 days apart. Some patients had ≥2 recurrences, while others had a single recurrence with a serious complication, ie, constrictive pericarditis, cardiac tamponade, or a large pericardial effusion with pericardiocentesis/pericardial window. Among these patients with multiple recurrences and/or complications, some had features relating to treatment history, including long‐term corticosteroid use (corticosteroids started within 30 days of flare, continuing ≥90 consecutive days) or inadequate treatment response (pericarditis recurring despite corticosteroids and/or colchicine, or other drugs [excluding NSAIDs] within 30 days of flare, or prior pericardiectomy). Patients (N=2096) had hypertension (60%), cardiomegaly (9%), congestive heart failure (17%), atrial fibrillation (16%), autoimmune diseases (18%), diabetes mellitus (21%), renal disease (20%), anxiety (21%), and depression (14%). Complications included pericardial effusion (50%), cardiac tamponade (9%), and constrictive pericarditis (4%). Pharmacotherapy included colchicine (51%), NSAIDs (40%), and corticosteroids (30%), often in combination. This study estimates 37 000 US patients with RP; incidence was 6.0/100 000/year (95% CI, 5.6‒6.3), and prevalence was 11.2/100 000 (95% CI, 10.6‒11.7). Conclusions Patients with RP may have multiple recurrences and/or complications, often because of inadequate treatment response and persistent underlying disease. Corticosteroid use is frequent despite known side‐effect risks, potentially exacerbated by prevalent comorbidities. Substantial clinical burden and lack of effective treatments underscore the high unmet need.

Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

“…Recurrence affect approximately 30% of patients within 18 months after a first episode of acute pericarditis [ 19 , 20 ]. This disease has a wide etiological spectrum but a specific cause is often not identified, and the diagnosis of idiopathic cases is essentially a diagnosis of exclusion, supported by the presence of ≥2 of the following: chest pain, pericardial friction/rub, electrocardiographic changes, and pericardial effusion without evidence of underlying infectious or noninfectious causes [ 21 , 22 ]. However, in the management of pericardial syndromes, a major controversy is the role of an extensive aetiological investigation and admission for all patients with pericarditis or pericardial effusion [ 17 , 23 ].…”

A Comparative Analysis of COVID-19 Vaccines Based on over 580,000 Cases from the Vaccination Adverse Event Reporting System

“…A: Cerebral thrombosis 2.4 [26] 2019 USA 14.5-28.5 [27] 2018 USA 13.2 [7] 2012 Netherlands 12.3 [28] 2008 Iran 2-5 [29] 2007 Great Britain 2.2 [30] 2001 Portugal 3.4 [31] 2001 Hong Kong B: Guillain-Barré syndrome 17.7 [32] 2019 Denmark 8.1-18.9 [33] 2014 Worldwide 13 [34] 2004 Worldwide C: Myocarditis 100-200 [35] 2021 Worldwide 102-1056 [36] 2017 Worldwide 104-400 [36] 2017 USA D: Pericarditis 78.3 [37] 2021 USA 33.2 [38] 2014 Finland 277 [39] 2007 Italy…”

Emerging Therapies for Recurrent Pericarditis: Interleukin‐1 inhibitors

“… 12 The most common autoimmune conditions associated with RP are systemic lupus erythematosus, systemic sclerosis or Sjogren syndrome and rheumatoid arthritis. 7 …”

“…Half of these patients are expected to develop a complication or require a procedure within 2 years of diagnosis. 7 After the first recurrence, half of these patients will continue to have persistent symptoms despite appropriate therapy. 8 The following criteria are established to make the diagnosis of RP: (1) proven first episode of acute pericarditis; (2) recurrence of pericarditis type pain; and (3) association with at least one of the following findings: pericardial friction rub, ECG changes, new or increased pericardial effusion, elevated CRP (C‐reactive protein) , evidence of pericardial inflammation established by an imaging modality (magnetic resonance imaging or computed tomography scan).…”

“… 12 , 13 , 14 Treatment adherence is also a major determinant and premature cessation of therapies from rapid tapering or intolerable side effects are contributors for the perpetuation of inflammation. 7 , 11 , 13 The standard of care in RP includes non‐steroidal NSAIDs, colchicine, and corticosteroids. Due to chronic use‐related side effects from corticosteroids, alternative regimens with azathioprine and human intravenous immunoglobulin have been implemented with variable success, though the level of evidence is limited.…”