A systematic review and meta-analysis of randomized controlled trials evaluating pharmacologic therapies for acute and recurrent pericarditis

Melendo-Viu, María; Marchán‐López, Álvaro; Lopez-Guarch, Carmen Jimenez; Roubín, Sergio Raposeiras; Abu‐Assi, Emad; Meneses, Rocío Tello de; Ynsaurriaga, Fernando Arribas; Hernández, Adrian V.; Bueno, Héctor

doi:10.1016/j.tcm.2022.02.001

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…In addition to this, to reduce the possible evolution to constrictive pericarditis and cardiomyopathy, underlying pathogenic mechanisms, such as viral infection or persistent and autoimmune-mediated myocardial injury, should be addressed. The immunosuppressive treatment of viral myopericarditis remains controversial, with some suggesting that immunosuppression may be beneficial in patients with systemic disease-related or autoimmune myocarditis but may increase viral replication and exacerbate myocardial injury in viral myocarditis ( 23 , 24 ). There is currently a lack of worldwide guidelines to support such treatment options.…”

Section: Discussionmentioning

confidence: 99%

Assistance of metagenomics next-generation sequencing for diagnosis of adenovirus pericarditis with pericardial effusion in a child: a case report and literature review

Lin

Zhang

2023

Front. Pediatr.

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Human adenoviruses (HAdVs) can cause infection at any age but are most common in the pediatric population, especially young children and infants, with a peak incidence in infants and children from 6 months to 5 years of age. Adenovirus infection can cause severe pneumonia, but pericarditis from adenovirus infection was rare. This article reports a case of a 2-year-old patient with pericarditis caused by adenovirus infection and a moderate pericardial effusion. We detected positive adenovirus nucleic acid in the patient’s blood by polymerase chain reaction assay. In addition, HAdVs were identified by metagenomics next-generation sequencing (mNGS) in blood and pericardial effusion. According to the test results and clinical practice, active symptomatic and supportive treatment was given, and finally the child recovered and was discharged from the hospital. Comprehensive and accurate diagnosis of pathogens is a prerequisite for effective treatment, and mNGS provides an effective means for diagnosing rare adenovirus myocarditis in children.

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Section: Discussionmentioning

confidence: 99%

Assistance of metagenomics next-generation sequencing for diagnosis of adenovirus pericarditis with pericardial effusion in a child: a case report and literature review

Lin

Zhang

2023

Front. Pediatr.

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“…Over the past years, several meta-analyses supported the benefits of colchicine [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. The most recent one [ 67 ], including all 6 available randomized clinical trials in acute and recurrent pericarditis (914 patients in total), demonstrated a significant lower recurrence and treatment failure rate with colchicine when compared to control (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27 to 0.51, and OR 0.29, 95% CI 0.21 to 0.41, respectively).…”

Section: Therapy: Il-1 Blockade As a Game Changer In Recurrent Perica...mentioning

confidence: 99%

Novel Pathophysiological, Diagnostic and Therapeutic Concepts in Acute and Recurrent Pericarditis

Bonaventura¹,

Thomas²,

Golino³

et al. 2023

Rev. Cardiovasc. Med.

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Acute pericarditis is the most frequent pericardial disease characterized by inflammation of the pericardial layers resulting in pain, dyspnea and fatigue. Often limited to an isolated event, up to 30% of patients experience one or more recurrences. There is limited knowledge about the pathophysiology of this disease, possibly due to the limited availability of animal models. More recently, following seminal clinical trials with colchicine and interleukin-1 (IL-1) blockers and a novel murine model of acute pericarditis using zymosan A, it has become clear that the NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) inflammasome/IL-1β axis plays a central role in driving acute pericardial inflammation and in sustaining this process during recurrences. Diagnostic management of pericarditis has been implemented with multimodality imaging including echocardiography, cardiac computed tomography, and cardiac magnetic resonance. These imaging modalities provide essential diagnostic and pathogenetic information, and are able to characterize pericardial inflammation, allowing to refine risk stratification and personalize treatment. Recent acquisitions yield relevant implications with regard to the therapeutic management of acute and recurrent pericarditis. Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are cornerstone therapies either for acute and recurrent pericarditis. However, the benefits of targeted agents, such as anakinra -a recombinant human IL-1 receptor antagonist -and rilonacept -an IL-1α/IL-1β trap, are being increasingly recognized. To this end, phenotyping patients with pericarditis and addressing such therapies to those presenting with auto-inflammatory features (elevated C-reactive protein, sustained pericardial and systemic inflammation, multiple recurrences) is of utmost importance to identify patients who might be more likely to benefit from NLRP3 inflammasome/IL-1β pathway blockade.

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“…Общие подходы к фармакотерапии перикардита, включающие применение НПВП, колхицина, ГК и иммуносупрессивных препаратов, рассмотрены в серии обзоров [91][92][93][94][95]. Особое внимание в последние годы привлечено к ГИБП, механизмы действия которых направлены на блокирование связывания ИЛ-1 с рецептором ИЛ-1 (анакинра) или эффектов самого ИЛ-1 (канакинумаб и рилонацепт) [96][97][98].…”

Section: применение анакинры при перикардитеunclassified

Problems of immunopathology and prospects for pharmacotherapy of idiopathic recurrent pericarditis: Using an interleukin 1 inhibitor (Anakinra)

Насонов

Sukmarova²,

Попкова³

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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Pericarditis, a clinical syndrome characterized by inflammation and thickening of the pericardium, is one of the most common forms of inflammatory diseases of the cardiovascular system. The most common and severe complication of acute pericarditis is idiopathic recurrent pericarditis (IRP), which has a poor prognosis associated with the risk of cardiac tamponade and constrictive pericarditis. The pathogenesis of pericarditis is associated with a complex interaction of environmental factors, genetic predisposition, and pathological activation of innate and acquired immunity. Autoinflammatory mechanisms associated with hyperproduction of interleukin (IL) 1 attract particular attention. Standard therapy for pericarditis includes non-steroidal antiinflammatory drugs, colchicine, glucocorticoids, and immunosuppressive drugs. A new direction in the pharmacotherapy of pericarditis is associated with the use of Anakinra (a recombinant non-glycosylated analog of an IL-1 receptor antagonist), which blocks the signaling of IL-1β and IL-1α. The materials of numerous studies are summarized, indicating that Anakinra is an effective drug for the treatment of patients with IRI who are resistant to standard therapy. It is assumed that the wider use of Anakinra, especially in the early stages of pericarditis, will not only improve the prognosis, but also be important for the identification of the autoinflammatory phenotype of IRI and the development of personalized therapy programs.

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A systematic review and meta-analysis of randomized controlled trials evaluating pharmacologic therapies for acute and recurrent pericarditis

Cited by 5 publications

References 29 publications

Assistance of metagenomics next-generation sequencing for diagnosis of adenovirus pericarditis with pericardial effusion in a child: a case report and literature review

Assistance of metagenomics next-generation sequencing for diagnosis of adenovirus pericarditis with pericardial effusion in a child: a case report and literature review

Novel Pathophysiological, Diagnostic and Therapeutic Concepts in Acute and Recurrent Pericarditis

Problems of immunopathology and prospects for pharmacotherapy of idiopathic recurrent pericarditis: Using an interleukin 1 inhibitor (Anakinra)

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