Immunological studies in a case of idiopathic relapsing pericarditis

Bird, A. G.; Mustchin, C P

doi:10.1093/eurheartj/8.suppl_j.199

Cited by 3 publications

(2 citation statements)

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“…Similarly, a case report described a 32‐year‐old man with a 7‐year history of IRP associated with dyspnea and myalgia . The patient presented with severe attacks, with elevated inflammatory markers, pericardial effusions, and cardiac tamponade.…”

Section: Literature Searchmentioning

confidence: 95%

Treatment of Adults with Idiopathic Recurrent Pericarditis: Novel Use of Immunotherapy

2017

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Idiopathic recurrent pericarditis (IRP) can be challenging to treat. Even after guideline-directed first-line treatment consisting of aspirin (ASA) or a nonsteroidal antiinflammatory drug (NSAID) in combination with colchicine therapy, recurrences still occur in greater than 20% of patients. Many patients then require treatment with long-term corticosteroids, which is not a favorable option due to their short- and long-term adverse effects. Because it is theorized that the pathophysiology of IRP may possess autoimmune sequelae, the use of immunotherapy for the treatment of IRP has emerged. In this review, we describe the literature associated with immunotherapy used to treat IRP in an adult population as well as provide an overview of the safety and monitoring parameters for each agent. The most common immunotherapies used after patients have had multiple recurrences of IRP are anakinra, intravenous immunoglobulin (IVIG), and azathioprine. In most cases, these immunotherapies are adjunctive therapy, with the goal of tapering and discontinuing immunosuppressive corticosteroids. After reviewing the data, anakinra resulted in more patients discontinuing corticosteroids and prevented further recurrences of pericarditis. IVIG resulted in symptom resolution and no further recurrences in most of the patients. Azathioprine was associated with more than half of patients becoming recurrence free; however, many patients required a restart of corticosteroids due to recurrence. Clinicians should be aware of the adverse effects of immunotherapy, ranging from mild gastrointestinal events to risk of infection and serious blood dyscrasias that may require diligent monitoring. The use of immunotherapy for the treatment of adults with IRP should be restricted to patients who have multiple recurrences. Ideally, immunotherapy would be adjunctive to first-line combination therapy with ASA/NSAID plus colchicine, with the goal of tapering and discontinuing immunosuppressive corticosteroids. Furthermore, clinicians should consider cost, drug-drug and drug-disease interactions, and safety, as well as the quality of the retrospective evidence before considering any immunotherapy.

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Section: Literature Searchmentioning

confidence: 95%

Treatment of Adults with Idiopathic Recurrent Pericarditis: Novel Use of Immunotherapy

2017

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“…We identified 96 citations and fully reviewed 20 reports; 12 were excluded (8 were duplicate publications, 4 dealt with alternative diagnoses). Finally, 8 were included (see Table 1 [1][2][3][4][5][6][7][8]), comprising 3 case reports and 5 case series.…”

Section: Literature Reviewmentioning

confidence: 99%

A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis

Scott

Hajela

Hawkins

et al. 2011

Journal of Cardiology Cases

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Idiopathic recurrent pericarditis (IRP) impairs quality of life. Although its precise etiology is not certain, it is believed to be immunologically mediated. Its optimal treatments are unknown. Initial therapy is with non-steroidal anti-inflammatory drugs and colchicine. Steroids, which are often used, however may promote recurrences. European guidelines advocate azathioprine or cyclophosphamide in refractory cases despite limited evidence. We report two adults with IRP successfully treated with the interleukin-1 antagonist, anakinra. We combine this experience with the first systematic literature review of immunosuppression in IRP. A total of 8 papers were included in the review, which alongside our patients described 18 cases. The best treatments comprised anakinra and intravenous immunoglobulin, with respective remission rates of 100% and 67%. Cyclophosphamide and azathioprine were less efficacious. The unprovoked inflammatory episodes in our patients alongside their prompt response to anakinra indicate that in some instances IRP may represent an autoinflammatory condition. We suggest that in IRP refractory to initial treatment, anakinra should be considered as a potential therapy. Clinical trials are required to confirm its benefits in IRP.

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Usefulness of Novel Immunotherapeutic Strategies for Idiopathic Recurrent Pericarditis

Lotan

Wasserstrum

Fardman

et al. 2016

The American Journal of Cardiology

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Immunological studies in a case of idiopathic relapsing pericarditis

Cited by 3 publications

References 0 publications

Treatment of Adults with Idiopathic Recurrent Pericarditis: Novel Use of Immunotherapy

Treatment of Adults with Idiopathic Recurrent Pericarditis: Novel Use of Immunotherapy

A case series and systematic literature review of anakinra and immunosuppression in idiopathic recurrent pericarditis

Usefulness of Novel Immunotherapeutic Strategies for Idiopathic Recurrent Pericarditis

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