Advances in Imaging and Targeted Therapies for Recurrent Pericarditis

Kumar, Sachin; Khubber, Shameer; Reyaldeen, Reza; Agrawal, Ankit; Cremer, Paul; Imazio, Massimo; Kwon, Deborah; Klein, Allan L.

doi:10.1001/jamacardio.2022.2584

Cited by 16 publications

(5 citation statements)

References 103 publications

(166 reference statements)

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“…An additional important point deals with patients’ phenotyping in order to provide a tailored therapy. Recent studies identified a central role for CMR in the diagnosis of acute pericarditis (e.g., LGE sequence and edema-weighted T2-weighted short-tau inversion recovery sequence) in patients experiencing multiple recurrences [ 34 , 38 , 86 ]. CMR can be coupled with the measurement of inflammatory biomarkers to recognize patients at higher risk for complications [ 87 , 88 ].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Назначение анакинры следует обсуждать в первую очередь у пациентов с ИРП, резистентных к терапии НПВП и колхицином (острый перикардит -3 мес., первый рецидив в пределах 6 мес. ), имеющих увеличение концентрации СРБ и/или признаки воспаления перикарда по данным МРТ [1,94]. По данным исследования IRAP [128], введение анакинры в дозе 100 мг/сут.…”

Section: Discussionunclassified

“…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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“…Alternative treatments proposed for this disorder were steroid-sparing agents; however, strong data on their overall efficacy are lacking [ 1 , 30 , 31 , 32 ]. Fortunately, the introduction of interleukin-1 (IL-1) blockers in the present decade constituted a paradigm shift towards the targeted therapy of colchicine-resistant glucocorticoid-dependent recurrent pericarditis [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

Interleukin-1 Blockers: A Paradigm Shift in the Treatment of Recurrent Pericarditis

Lazarou,

Koutsianas,

Theofilis

et al. 2024

Life

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Recurrent pericarditis is a problematic clinical condition that impairs the quality of life of the affected patients due to the need for repeated hospital admissions, emergency department visits, and complications from medications, especially glucocorticoids. Unfortunately, available treatments for recurrent pericarditis are very limited, including only a handful of medications such as aspirin/NSAIDs, glucocorticoids, colchicine, and immunosuppressants (such as interleukin-1 (IL-1) blockers, azathioprine, and intravenous human immunoglobulins). Until recently, the clinical experience with the latter class of medications was very limited. Nevertheless, in the last decade, experience with IL-1 blockers has consistently grown, and valid clinical data have emerged from randomized clinical trials. Accordingly, IL-1 blockers are a typical paradigm shift in the treatment of refractory recurrent pericarditis with a clearly positive cost/benefit ratio for those unfortunate patients with multiple recurrences. A drawback related to the above-mentioned medications is the absence of universally accepted and established treatment protocols regarding the full dose administration period and the need for a tapering protocol for individual medications. Another concern is the need for long-standing treatments, which should be discussed with the patients. The above-mentioned unmet needs are expected to be addressed in the near future, such as further insights into pathophysiology and an individualized approach to affected patients.

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Advances in Imaging and Targeted Therapies for Recurrent Pericarditis

Cited by 16 publications

References 103 publications

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

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)

Interleukin-1 Blockers: A Paradigm Shift in the Treatment of Recurrent Pericarditis

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